Subject(s)
Humans , Male , Child , Anesthetics, Inhalation/adverse effects , Sevoflurane/adverse effects , Lung/blood supply , Hypoxia/chemically induced , Prognosis , Severity of Illness Index , Constriction, Pathologic/chemically induced , Constriction, Pathologic/prevention & control , Hypoxia/prevention & controlABSTRACT
OBJECTIVE: We aimed to evaluate the efficacy and safety of a newly developed, partially retrievable flow-diverter (the FloWise) in an elastase-induced rabbit aneurysm model. MATERIALS AND METHODS: We developed a partially retrievable flow diverter composed of 48 strands of Nitinol and platinum wire. The FloWise is compatible with any microcatheter of 0.027-inch inner diameter, and is retrievable up to 70% deployment. The efficacy and safety of the FloWise were evaluated in the elastase-induced rabbit aneurysm model. The rate of technical success (full coverage of aneurysm neck) and assessment of aneurysm occlusion and stent patency was conducted by angiograms and histologic examinations at the 1-month, 3-month, and 6-month follow-up. The patency of small arterial branches (intercostal or lumbar arteries) covered by the FloWise were also assessed in the 5 subjects. RESULTS: We attempted FloWise insertion in a total of 32 aneurysm models. FloWise placement was successful in 31 subjects (96.9%). Two stents (6.2%) were occluded at the 3-month follow-up, but there was no evidence of in-stent stenosis in other subjects. All stented aneurysms showed progressive occlusion: grade I (complete aneurysm occlusion) in 44.4% and grade II (aneurysm occlusion > 90%) in 55.6% at 1 month; grade I in 90% and II in 10% at 3 months; and grade I in 90% and II in 10% at 6 months. All small arterial branches covered by the FloWise remained patent. CONCLUSION: A newly developed, partially retrievable flow-diverter seems to be a safe and effective tool of aneurysm occlusion, as evaluated in the rabbit aneurysm model.
Subject(s)
Animals , Humans , Male , Rabbits , Alloys , Aneurysm/chemically induced , Angiography , Arteries/pathology , Catheters , Cerebrovascular Circulation/physiology , Constriction, Pathologic/chemically induced , Disease Models, Animal , Pancreatic Elastase/pharmacology , Platinum , Stents/adverse effectsABSTRACT
La ingestión accidental de sustancias cáusticas en pediatría es frecuente. La estenosis esofágica (EE) secundaria a esofagitis cáustica (EC) es una grave complicación. El tratamiento de elección de la EE es la dilatación endoscópica con balón neumático. La mayoría de los pacientes tienen una buena respuesta pero requieren dilataciones reiteradas La falla del mismo obliga al tratamiento quirúrgico. En este estudio se analizó en forma retrospectiva la evolución de los niños con EC y el tratamiento de aquellos que presentaron EE. Ingresaron al estudio todos los niños con EC del Servicio de Endoscopia del Hospital Pereira Rossell entre enero de 1997 y diciembre de 2002. Se incluyeron 92 pacientes en los que se diagnosticó esofagitis. La edad promedio fue 2,8 años; 61 varones. La sustancia ingerida con mayor frecuencia fue alcalina. Los grados de EC fueron: grado I, 35 (38 por ciento); grado IIa, 23 (25 por ciento); grado IIb, 16 (17 por ciento); grado IIIa, 10 (10,8 por ciento ) y grado IIIb , 8 (8,7 por ciento). Nueve evolucionaron a estenosis (dos con esofagitis grado IIb, dos con esofagitis grado IIIa y cinco con lesión grado IIIb). El número total de dilataciones fue 168 (promedio 18,6). Cinco niños no requir ieron más dilataciones, dos continúan en tratamiento y dos necesitaron cirugía (promedio de seguimiento 10,5 meses). Si bien el número de niños es pequeño, se concluye que las esofagitis cáusticas moderadas y severas (grado II y III respectivamente) evolucionaron con mayor frecuencia a la estenosis, el tratamiento con balón neumático logró solucionarla y se acompañó de un bajo número de complicaciones. Destacamos la importancia de las medidas de prevención.
Subject(s)
Humans , Child , Catheterization , Esophagitis , Constriction, Pathologic/chemically induced , Esophageal Stenosis/chemically inducedABSTRACT
BACKGROUND: Corrosive injuries of the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's experience in managing patients with corrosive strictures of the stomach. METHODS: Records of 28 patients who underwent definitive surgery for corrosive strictures of the stomach in our institution over a 15-year period were reviewed. RESULTS: The main presenting complaints were vomiting (75%), dysphagia (46%) and significant weight loss (100%). Pre-operative evaluation included barium and endoscopic studies. Most patients had antro-pyloric strictures (n=22); in 6 patients, however, near-total or total gastric involvement was observed. Thirteen (46%) patients had associated strictures of the esophagus; of these, 7 responded to esophageal dilation. Strictures of the stomach were managed with resectional procedures like distal gastrectomy (n=16), subtotal gastrectomy (1) or total gastrectomy (3) and esophagogastrectomy (1) in 21 (75%) patients. The remaining 7 patients underwent bypass procedures like gastrojejunostomy (5), stricturoplasty (1), and colonic bypass of esophagus and stomach (1). Three patients had entero-cutaneous fistulae in the postoperative period. One patient died in hospital of septicemia and malnutrition. CONCLUSIONS: In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results.
Subject(s)
Adolescent , Adult , Anastomosis, Surgical , Burns, Chemical/etiology , Caustics/poisoning , Constriction, Pathologic/chemically induced , Developing Countries , Esophageal Stenosis/chemically induced , Female , Follow-Up Studies , Gastrectomy/methods , Gastric Outlet Obstruction/chemically induced , Humans , India , Male , Middle Aged , Pyloric Stenosis/chemically induced , Retrospective Studies , Risk Assessment , Survival Rate , Treatment OutcomeABSTRACT
Relatamos caso de aracnoidite constritiva torácica, verificada 10 anos após o uso de pantopaque, que foi utilizado em mielografia no diagnóstico de cisto aracnóideo