Long-term results of oversized balloon dilation for benign anastomotic biliary strictures: initial two-center experience

Abstract Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication—a small dehiscence of the anastomosis—which extended the catheter dwell time. Minor complications occurred in two cases—one small perihepatic hematoma and one segmental thrombosis of the left portal branch—neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.

Resumo Objetivo: Descrever o procedimento, avaliar a viabilidade e perviedade em longo prazo da dilatação biliar trans-hepática percutânea usando a técnica de dilatação por balão superdimensionado para o tratamento em uma única etapa de estenose biliar anastomótica benigna após cirurgia hepatobiliar. Materiais e Métodos: Este estudo retrospectivo de dois centros incluiu 16 casos consecutivos de estenoses bilioentéricas benignas sintomáticas. A dilatação das estenoses com superdimensionamento do balão de 40-50% foi realizada após avaliação pré-procedimento do diâmetro do ducto biliar por tomografia computadorizada ou ressonância magnética e um dreno externo foi colocado. Os sintomas clínicos e exames laboratoriais foram avaliados a cada três meses após a remoção do dreno, enquanto o acompanhamento radiológico foi realizado com ressonância magnética em 30 dias e tomografia computadorizada em 6 e 12 meses. Resultados: O tempo médio de seguimento foi de 31,8 ± 8,15 meses. As estimativas de perviedade em um, dois e três anos foram 88,2%, 82,4% e 82,4%; respectivamente. Houve uma complicação importante, com pequena deiscência da anastomose biliodigestiva, que exigiu prolongamento do tempo de permanência do dreno externo. Complicações menores ocorreram em dois casos, um pequeno hematoma peri-hepático e uma trombose segmentar do ramo portal esquerdo e nenhum deles necessitou de intervenção adicional. Conclusão: A técnica de dilatação com balão superdimensionado para o tratamento de estenoses biliares anastomóticas benignas foi viável para o tratamento de estenoses anastomóticas bilioentéricas benignas. A técnica parece estar associada a altas taxas de perviedade e de sucesso clínico no longo prazo.

Levels of aqueous and serum VEGF, TGF-β1 ,IL-6 in neovascular glaucoma eyes / 中华实验眼科杂志

Background Neovascular glaucoma (NVG) is a refractory disease characterized by neovascularization,and its pathogenesis mechanism is still unelucidated.Researches showed that muhicytokins and inflammatory factors are associated with neovascularization,however,the correlation of these factors with NVG worth attention.Objective This study was to detect the vescular endothelial growth factor (VEGF),transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) levels in aqueous humor and plasma in NVG eyes and its significance.Methods A prospective cases-controlled study was performed under the approval of Ethic Committee of Shanghai East Hospital and informed consent of patients.Eight eyes of 8 NVG patients,10 eyes of 10 primary open angle glaucoma (POAG) patients and 10 eyes of age-related cataract (ARC) patients were entrolled in Shanghai East Hospital from May,2014 to March,2015.The periphery blood of 3-4 ml was collected from all the patients to prepare 0.3-0.4 ml serum,and 0.1-0.2 ml aqueous humor was collected during the surgery from each eye.The aqueous and serum levels of VEGF,TGF-β1 and IL-6 were measured by ELISA.Results The aqueous humor and plasma VEGF concentrations in NVG patients were (2 769.85 ± 390.88) pg/ml and (529.93 ± 95.20) pg/ml,respectively,which were higher than (208.12 ± 58.59) pg/ml and (219.28 ± 24.44) pg/ml in POAG patients as well as (158.88 ±12.35) pg/ml and (172.82±31.91)pg/ml in ARC patients,with significant differences among the three groups (aqueous:F=433.80,P＜0.01;plasma:F=103.84,P＜0.01).The levels of TGF-β1 in aqueous humor and plasma from NVG patients were (157.94±113.00)pg/ml and (3 895.78±2 318.00)pg/ml,showing significant increases in comparison with (54.48±35.58) pg/ml and (2 196.13±1 185.39) pg/ml in the POAG patients or (47.98±17.69) pg/ml and (1937.28±933.27) pg/ml in the ARC patients (aqueous:F =7.88,P＜0.01;plasma:F =4.18,P＜0.05).The concentration of IL-6 in aqueous humor and plasma were (234.87±41.64) pg/ml and (26.97±8.19) pg/ml from NVG patients,with considerable elavation in comparison with (38.97± 19.06)pg/ml and (19.54±5.11)pg/ml in the POAG patients or (29.48±14.61) pg/ml and (18.50±3.57) pg/ml in the ARC patients (aqueous:F =166.27,P＜0.01;plasma:F=5.59,P＜0.05).Conclusions The aqueous and plasma VEGF,TGF-β1 and IL-6 are considerably higher in NVG patients than those in POAG patients and ARC patients,suggesting that these cytokines participate in the pathogenesis and development of the NVG and probably are treating target of NVG.

Assessing ectasia susceptibility prior to LASIK: the role of age and residual stromal bed (RSB) in conjunction to Belin-Ambrósio deviation index (BAD-D) / Avaliação de suscetibilidade para ectasia antes de LASIK: o papel da idade e do leito estromal residual em conjunto ao índice Belin-Ambrósio (BAD-D)

Purpose: To compare the ability to detect preoperative ectasia risk among LASIK candidates using classic ERSS (Ectasia Risk Score System) and Pentacam Belin-Ambrósio deviation index (BAD-D), and to test the benefit of a combined approach including BAD-D and clinical data. Methods: A retrospective nonrandomized study involved preoperative LASIK data from 23 post-LASIK ectasia cases and 266 stable-LASIK (follow up > 12 months). Preoperative clinical and Pentacam (Oculus; Wetzlar, Germany) data were obtained from all cases. Mann-Whitney's test was performed to assess differences between groups. Stepwise logistic regression was used for combining parameters.The areas under the Receiver Operating Characteristic (ROC) curves (AUC) were calculated for all parameters and combinations, with pairwise comparisons of AUC (DeLong's method). Results: Statistically significant differences were found for age, residual stromal bed (RSB), central corneal thickness and BAD-D (p<0.001), but not for sphere, cylinder or spherical equivalent (p>0.05). ERSS was 3 or more on 12/23 eyes from the ectasia group (sensitivity = 52.17%) and 48/266 eyes from the stable LASIK group (18% false positive). BAD-D had AUC of 0.931 (95% CI: 0.895 to 0.957), with cut-off of 1.29 (sensitivity = 87%; specificity = 92.1%). Formula combining BAD-D, age and RSB provided 100% sensitivity and 94% specificity, with better AUC (0.989; 95% CI: 0.969 to 0.998) than all individual parameters (p>0.001). Conclusion: BAD-D is more accurate than ERSS. Combining clinical data and BAD-D improved ectasia susceptibility screening. Further validation is necessary. Novel combined functions using other topometric and tomographic parameters should be tested to further enhance accuracy. .

Objetivo: Comparar a capacidade de detectar risco de ectasia no pré-operatório de LASIK usando o clássico ERSS (Ectasia Risk Score System) e índice Belin- Ambrósio (BAD- D) do Pentacam; e para testar o benefício de uma abordagem combinada, incluindo BAD-D e dados clínicos. Métodos: Estudo não randomizado retrospectivo envolveu dados pré-operatórios de LASIK de 23 casos que evoluíram para ectasia pós-LASIK e 266 casos estáveis após LASIK com acompanhamento mínimo de 12 meses. Dados préoperatórios clínicos e do Pentacam (Oculus, Wetzlar, Alemanha) foram obtidos para todos os casos. O teste de Mann-Whitney foi realizado para avaliar as diferenças entre grupos. Regressão logística foi utilizada para combinar parâmetros. As áreas sob as curvas Receiver Operating Characteristic (ROC; AUC) foram calculadas para todos os parâmetros e as combinações. Comparações de pares das AUC foram realizadas com método de DeLong. Resultados: Foram encontradas diferenças estatisticamente significativas para a idade, residual leito estromal (RSB), espessura corneana central e BAD- D (p <0,001), mas não para a grau esférico, cilindro ou equivalente esférico (p > 0,05). ERSS foi de três ou mais em 12/23 olhos do grupo ectasia (sensibilidade = 52,17 %) e 48/ 266 olhos do grupo LASIK estável (18% falso positivo). BAD- D teve AUC de 0,931 (IC 95%: 0,895-0,957), com corte de 1,29 (sensibilidade=87%, especificidade=92,1%). A fórmula que combinou BAD-D, idade e RSB, gerou 100% de sensibilidade e especificidade de 94%, com melhor AUC (0,989, IC 95%: 0,969-0,998) do que todos os parâmetros individuais (p>0,001). Conclusão: BAD-D é mais preciso do que ERSS. Combinações de dados clínicos e os BAD-D melhorou a capacidade de identificação ...

The Pathologic Analysis of Chronic Renal Failure in Renal Allograft Recipients / 대한이식학회지

As the patients with chronic renal failure (CRF) are usually diagnosed by clinical data, the exact etiology of renal disease is obscure in most renal allograft recipients. Recognition of original disease is important to manage the recipients after renal transplantation, because many renal diseases leading to CRF, such as glomerulonephritis (GN), diabetes, and hypertension, are known to recur and affect the prognosis of the renal recipients. PURPOSE: We investigated the excised native kidney to know the pathologic etiology of CRF in allograft recipients. We classified the pathologic entities and compared them with the clinical data. METHODS: Total 30 recipients without pathologic diagnosis for CRF were included in this study from June, 2000 to July, 2001. We performed pathologic and immunologic examination of native kidney obtained by unilateral nephrectomy of the recipients at the time of renal transplantation. We analyzed the preoperative clinical data to compare with the pathologic findings. RESULTS: The mean age of the recipients was 41 (23~59) years, and male to female ratio was 3 : 2 (male : female =18 : 12). All recipients except two were primary renal transplants. The mean duration of pre-transplant dialysis was 400 (5~2970) days. The presumptive clinical diagnosis for CRF was made in 22 out of 30 cases (73%), and unknown in remaining 8 cases (27%). The pathologic diagnosis was made in 27 cases (90%), and it couldn't be made in the remaining three (10%) due to presence of severe chronic pathologic changes. Twenty cases (67%) were GN, including 8 chronic sclerosing GN, 7 IgA nephropathy, 2 membranoproliferative GN, 2 focal segmental GN, 1 mesangial proliferative GN. Four cases (13%) were tubulointerstitial disease (2 reflux nephropathy, 1 chronic pyelonephritis, 1 chronic tubulointerstitial nephritis). Three cases (10%) were systemic disease (2 diabetic nephropathy, 1 Wegener's granulomatosis). The preoperative diagnosis was different with the pathologic diagnosis in four (18%) out of 22 cases having presumptive clinical diagnosis. We could make a pathologic diagnosis in six out of seven clinically unknown cases. CONCLUSION: The pathologic diagnosis was made in 90 percent of renal recipients with CRF at the time of renal transplantation. The accurate diagnosis in the renal recipients is necessary and very important to manage the recipients and predict the prognosis after renal transplantation.