Treatment of Symptomatic Ureteral Calculi during Pregnancy / 中国医科大学学报

Objective To present our experience with the management of symptomatic ureteral calculi during pregnancy and to compare the effi?cacy of two treatments:double?J stent insertion and ureteroscopy. Methods In a retrospective study between January 2007 and January 2015,38 pregnant women were treated for symptomatic ureteral calculi in our hospital. The patients were divided into two groups based on whether they re?ceived double?J stent insertion(n=21)or ureteroscopic lithotripsy(n=17). We collected and compared the patients 'characteristics and treat?ment outcomes,such as success ratio,rate of complications,surgical time,medical costs,and hospitalization time. Results In the double?J group, the insertion of a double?J stent was possible for 17 of 21 patients(success rate,81.0%). In the ureteroscopy group,15 of 17 patients had complete calculi fragmentation(success rate,88.2%). Complications in the double?J stent retention group were slightly higher than in the ureteroscopic litho?tripsy group. The medical costs and hospitalization time required to perform ureteroscopic lithotripsy were significantly higher compared to double?J stent insertion. Patients in the double?J group contended with stones after delivery. Conclusion Both of double?J stent insertion and ureteroscopic lithotripsy are effective for the treatment of symptomatic ureteral calculi during pregnancy. The success rate of ureteroscopy ,which can directly dis?rupt stones,was higher. However,double?J stent insertion costs less and is simple and convenient. The technique that is chosen to be performed de?pends on the patient's practical situation and personal preference.

Glaucoma Schlemm's canal stent insertion: a systematic review

Schlemm's canal stent insertion is a procedure for controlling the intraocular pressure by inserting a stent in the anterior chamber in patients with open-angle glaucoma. The objective of this review is to evaluate the safety and effectiveness of Schlemm's canal stent insertion for glaucoma. Searches of key databases, including 8 Korean databases, Medline, Embase, and Cochrane Library, were searched. Among 249 articles located in the search, a total of 14 studies (4 randomized controlled trials and 10 case series) were included in this review. Two review authors independently selected the studies and assessed their quality. On the basis of current data, we recommend that Schlemm's canal stent insertion is safe and effective for reducing intraocular pressure and the number of anti-glaucoma medications being administered for patients with open angle glaucoma.

Experience on the diagnosis and treatment of intrathoracic gastro-airway fistulae after esophagectomy for esophageal carcinoma / 中华胸心血管外科杂志

Objective To summarize our results and experience in dealing with the postoperative intrathoracic gastro-air-way fistulae after esophagectomy for esophageal carcinoma.Methods From January 2010 through February 2012,1490 patients with esophageal carcinoma underwent esophagectomy in our department.The postoperative intrathoracic gastro-airway fistulae were documented in 10 patients,with a frequency of 0.67％.Five of them died.The possible etiology,clinical characters,treatment and prevention of this complication were reviewed.Results The location of the fistulate were 7 at left main bronchus,1 at right main bronchus,and 2 at distal trachea.After 2-3 weeks conservative treatment,1 patient underwent primary surgical repair and cured,1 refused any further intervention and sacrified,8 patients underwent endoscopic insertion of covered stent and only 3 healed.For the remaining 5 cases with failed stent therapy,2 died of severe aspiration and lung infection,3 had surgical repair,one of them successed and 2 died of aspiration and aortic rupture,respecively.Conclusion The development of intrathoracic gastro-airway fistulae was associated with the iatrogenic injuries and suturing material irritation of the gastric tube to the tracheal/bronchial wall.Therefore,a meticulous closure and wapping of gastroplasty and appropriate isolation using artifical patch or great omentum between airway and esophageal substitution could effectively reduce the fistulae.The stent therapy usually fails in treating this entity and surgical repair remains the final and ratical therapeutic option.Primary repaire is suggested and careful preoperative assessment is crucial.

Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers

PURPOSE: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for non-obstructive left-sided colon cancer. METHODS: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. RESULTS: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8+/-5.3 vs. 14.0+/-8.7, P=0.036), and distal resection margin (5.5+/-3.0 cm vs. 3.6+/-2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. CONCLUSION: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.

A Case of Afferent Loop Syndrome after Inserting a Double-Layered Pyloric Stent for Gastric Outlet Obstruction in a Patient with Stump Gastric Cancer after Undergoing Billroth II Radical Subtotal Gastrectomy / 대한소화기내시경학회지

Stent insertion is an effective method for treating a patient with gastric outlet obstruction that's caused by recurred cancer at the anastomosis site. There are some complications associated with stent insertion, such as perforation, bleeding, ulceration and obstruction. There are only rare Korean case reports of afferent loop syndrome after stent insertion. We report here on a case of afferent loop syndrome that occurred after insertion of a double-layered pyloric stent for gastric outlet obstruction in a patient with stump gastric cancer after undergoing Billroth II radical subtotal gastrectomy.

The Effect of Self-Expanding Metallic Stent Insertion for the Treatment ofMalignant Colorectal Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical and cost effectiveness of the use of stent insertion for malignant colorectal obstruction as compared with performing emergency surgery. METHODS: We retrospectively reviewed the medical records of 201 patients. Malignant colorectal obstructions caused by a resectable tumor were treated with preoperative stenting followed by surgery (group A, n=55) or emergency surgery (group B, n=59). Malignant obstructions caused by an unresectable cancer were treated with palliative stenting (group C, n=58) or palliative emergency surgery (group D, n=29). RESULTS: The one-staged radical resection rate was significantly higher in group A patients than in group B patients (87.3% vs. 52.5%, p<0.05). Post-operative complications were more frequent in group A patients than in group B patients (9.1% vs. 32.2%, p<0.05). The admission period was significantly shorter for group A patients than for group B patients (25.0 days vs. 33.7 days, p<0.05). The medical cost was not different for group A and group B patients. Life-long stoma formation was necessary for 15.5% of group C patients and 69% of group D patients, respectively. The admission period was significantly shorter for group C patients than group D patients (10.5 days vs. 22.7 days, p<0.05). The medical cost was not different for group C and D patients. CONCLUSIONS: Stent insertion was an effective treatment modality for malignant colorectal obstruction.

Clinical Outcomes after Peripheral Balloon Angioplasty or Stent Insertion in Patients with Peripheral Arterial Obstructive or Stenotic Disease

PURPOSE: Percutaneous peripheral balloon angioplasty and stent insertion are used for the treatment of peripheral arterial obstructions and stenosis. In this study, we assessed the efficacy of peripheral balloon angioplasty and stent insertion in patients with peripheral arterial disease. METHOD: We performed a retrospective review of patients who underwent peripheral balloon angioplasty or stent insertion in obstructive or stenotic peripheral arterial lesions between July 2003 and November 2006. Follow-up study was performed using lower extremity multi-directional computed tomography (MDCT) or lower extremity angiography. Mean follow-up was 22.8 months. RESULT: A total of 30 patients (47 lesions) were treated. The mean age was 66.8 years, and the ratio of male to female patients was 29 to 1. Calf claudication was the most common chief complaint, and 19 patients had hypertension. Obstructive lesions were found in the common iliac artery (CIA) (18), external iliac artery (EIA) (11), superficial femoral artery (SFA) (15), and anterior tibial artery (ATA) (3). Peripheral balloon angioplasty was performed for 8 lesions, and stent insertion was performed for 39 lesions. Re-stenosis occurred in 9 lesions (3 in the CIA, 5 in the SFA, 1 in the ATA) during follow-up. CONCLUSION: Peripheral balloon angioplasty and stent insertion are useful modalities for the treatment of obstruction or stenosis in lower extremity peripheral arteries. Close follow-up is necessary to improve long-term outcomes.

An anomalous union of the pancreaticobiliary duct that was treated by drainage of the accessory ampulla / 대한내과학회지

An anomalous union of the pancreaticobiliary duct is defined as a condition in which the junction between the common bile duct and the pancreatic duct is located outside the duodenal wall. Therefore, the sphincter of Oddi does not influence the junction; there is always communication between these ducts, and so pancreatic juice flows into the biliary tract through the communication, which may cause pancreaticobiliary diseases. Pancreas divisum is a congenital variant of the pancreatic ductal anatomy, and the mechanism is that the dorsal and ventral pancreatic buds fail to fuse during the gestation. We report here on a 21 year old woman who previously had suffered with recurrent pancreatitis, and an anomalous union of the pancreaticobiliary duct associated with the incomplete type of pancreas divisum was revealed by ERCP. She was treated with minor papilla sphincterotomy and stent insertion.

A Case of Recurrent Frontal Sinus Mucocele Complicated by Visual Disturbance and Treated by Endoscopic Marsupialization and Intrafrontal Stent Insertion

Paranasal sinus mucocele is a slowly expanding benign lesion which can occur as a result of obstruction in the sinus ostium or ostial tract. Frontal sinus mucocele differ from mucoceles of other sinuses in that the frontal outflow tract is usually narrower and less accessible. Since the introduction of endoscopic sinus surgical instrument and techniques, there has been an increasing trend towards the use of endoscopic transnasal technique for managing the paranasal sinus mucoceles. Some studies also recommend the use of intrafrontal stent to reduce the rate of restenosis of frontal sinus outflow tract. We experienced a case of recurrent frontal sinus mucocele complicated by visual disturbance and periorbital swelling. To treat this condition, an intranasal marsupialization was performed and an intrafrontal stent was applied. This paper reports the particulars of this case with a review of related literature.

Interventional Therapy for Deep Venous Thrombosis in the Lower Limbs / 中国微创外科杂志

Objective To investigate the clinical effectiveness of interventional therapy for deep venous thrombosis(DVT) in the lower limbs.Methods A total of 38 patients with DVT were treated by intravenous thrombolysis;12 of them received percutaneous transluminal balloon angioplasty and intravascular stenting after the thrombolysis.According the evaluation criteria of our hospital,the outcomes of the patients were classified as cure(angiography showed complete lysis of the thrombus and smooth venous wall),markedly improved(the deep vein was patent with intravascular mural thrombi,the inner radius was reduced by less than 1/3),improved(angiography showed residual thrombi in the deep vein,and the inner radius was reduced by more than 1/3),and failure(the vein was still obstructed).Results After the treatments,cure was achieved in 22 patients,markedly improved in 14,and improved in 2.No severe complications occurred during the operations.Thirty-four of the patients were followed up for 3-24 months(3-6 months in 7 cases,7-12 months in 12,and 13-24 months in 15).Two patients had recurrence during the follow-up and were cured by intravenous thrombolysis.Conclusion Interventional therapy is continent,effective,and safe for DVT.

Comparison of balloon angioplasty , stent insertion and medical therapy in the treatment of single LAD lesion / 대한내과학회지

With recent advances in transarterial interventional technique, there is a tendency to treat single LAD lesion with balloon angioplasty or stent insertion rather than with medical therapy alone. Therefore, it is important to evaluate the long-term clinical outcomes of such interventional therapy. METHODS: Subjects are comprised of patients who underwent coronary angiogram from 1993 to 1996 and diagnosed as having single LAD lesion without decrease of left ventricular fuction. The incidence of major ischemic complications, revascularization and reduction of angina pectoris after different therapeutic strategies in these patients are evaluated. RESULT: 1) There was total of 190 patients. Patients receiving medical therapy, balloon angioplasty and stent insertion were 70, 75, and 45 respectively. There was no significant difference in mean age, sex ratio, and risk factors of coronary artery occlusive disease between each groups. 2) The medical therapy group(30%) had a significantly lower incidence of proximal stenosis lesion compared to the balloon angioplasty group (45%) and stent insertion group(52%) according to the location of the lesion(p0.05). CONCLUSION: For patients with single LAD stenotic lesion interventional therapies such as balloon angioplasty and stent insertion might be more effective without statistical signigicance in reducing chest pain compared to medical therapy. There was no significant difference in the incidence of ischemic complication and rate of revascularization among different study groups. Further studies will be needed to clarify the beneficial effects of interventional coronary artery therapy such as improvement of chest pain, increased exercise capacity, and improved quality of life along with other parameters.

Comparison of balloon angioplasty , stent insertion and medical therapy in the treatment of single LAD lesion / 대한내과학회지

With recent advances in transarterial interventional technique, there is a tendency to treat single LAD lesion with balloon angioplasty or stent insertion rather than with medical therapy alone. Therefore, it is important to evaluate the long-term clinical outcomes of such interventional therapy. METHODS: Subjects are comprised of patients who underwent coronary angiogram from 1993 to 1996 and diagnosed as having single LAD lesion without decrease of left ventricular fuction. The incidence of major ischemic complications, revascularization and reduction of angina pectoris after different therapeutic strategies in these patients are evaluated. RESULT: 1) There was total of 190 patients. Patients receiving medical therapy, balloon angioplasty and stent insertion were 70, 75, and 45 respectively. There was no significant difference in mean age, sex ratio, and risk factors of coronary artery occlusive disease between each groups. 2) The medical therapy group(30%) had a significantly lower incidence of proximal stenosis lesion compared to the balloon angioplasty group (45%) and stent insertion group(52%) according to the location of the lesion(p0.05). CONCLUSION: For patients with single LAD stenotic lesion interventional therapies such as balloon angioplasty and stent insertion might be more effective without statistical signigicance in reducing chest pain compared to medical therapy. There was no significant difference in the incidence of ischemic complication and rate of revascularization among different study groups. Further studies will be needed to clarify the beneficial effects of interventional coronary artery therapy such as improvement of chest pain, increased exercise capacity, and improved quality of life along with other parameters.

Therapy of Tracheal Stenosis with Spiral Metallic Stent(A Report of 2 Cases) / 介入放射学杂志

Purpose:To evaluate the efficacy of using z shape spiral metallic stent in the treatment of tracheal stenosis after lung resectomy and carinal plastic surgery.Materials and meth- ods:Two patients suffered from lung cancer received lung resectomy and carinal plastic surgery, thereafter,tracheamalacia occurred in one patient and intratracheal granulation tissue proliferation in the other,both resulted in tracheal stenosis.Spiral metallic stents were inserted in the narrow seg- ment under bronchoendoscopy.Results:Dyspnea relieved immediatly and the patients were soon free fron respirator and returned home.A 2.5-year-follow-up showed no recurrence in the first patient.Conclusion:Intratracheal insertion of stent is an effective way in treating tracheal stenosis.

Intravascular Stent Insertion for Treatment of Inferior Vera Cava Obstruction / 介入放射学杂志

8 cases of inferior vena cava obstruction were treated with intravascular stent insertion,including 3 membranacous obstructions and 5 segmental obstructions.All 8 cases obtained successful results without Severe complications.4 cases were checked up half a year later(2 of which were to checked after one year)with stents still in position and pa- tency of all.inferior vena cavas.In present studies the insertion technique and prevention of complication were discussed.