ABSTRACT
PURPOSE: To report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL). PATIENTS AND METHODS: A retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46±18 (SD) years (range: 23-75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes. RESULTS: Eleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3-84 months). CONCLUSION: For patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.
Subject(s)
Cholelithiasis/therapy , Lithotripsy, Laser , Adult , Aged , Cholangitis/etiology , Female , Humans , Lasers, Solid-State , Lithotripsy, Laser/adverse effects , Male , Middle Aged , Recurrence , Retreatment , Retrospective Studies , Young AdultABSTRACT
Interleukin-10 (IL-10) is intensely studied, yet little is known about the mechanisms that control IL-10 expression. We identified striking similarities between IL-10 and interferon-gamma (IFN-gamma) regulation in mouse natural killer (NK) cells. Like IFN-gamma, IL-10 expression is induced by IL-2 and IL-12 and IL-2+IL-12 stimulation is synergistic. Unlike IFN-gamma, neither IL-18 nor Ly-49D cross-linking induced IL-10 expression however. Additionally, the IL-12 homologs IL-23 and IL-27 also do not regulate NK cell-specific IL-10. We determined that a small population of NK cells accounts for IL-10 production. The induction of IL-10 by IL-2+IL-12 treatment in NK cells appears to be biphasic, with an initial burst of expression which diminishes by 12 h but spikes again at 18 h. We determined that much like IFN-gamma, Stat4 is largely required for IL-12-induced IL-10. Conversely, we observed normal induction of IL-10 in T-bet-deficient NK cells. We identified a Stat4-binding element in the fourth intron of the Il10 gene, which is completely conserved between mouse and human. This intronic Stat4 motif is within a conserved noncoding sequence, which is also a target for cytokine-induced histone acetylation. These findings highlight tissue- and receptor-specific IL-10 regulatory mechanisms, which may be part of an early feedback loop.
Subject(s)
Interleukin-10/biosynthesis , Killer Cells, Natural/immunology , STAT4 Transcription Factor/metabolism , T-Box Domain Proteins/physiology , Animals , Cell Culture Techniques , Cells, Cultured , Drug Synergism , Interferon-gamma/metabolism , Interleukin-10/genetics , Interleukin-12/pharmacology , Interleukin-2/pharmacology , Killer Cells, Natural/metabolism , Kinetics , Mice , Mice, Inbred C57BL , RNA, Messenger/analysis , RNA, Messenger/metabolism , STAT4 Transcription Factor/chemistry , STAT4 Transcription Factor/genetics , Spleen/cytology , Stimulation, Chemical , Time FactorsABSTRACT
Knotting of intravascular catheters is an uncommon but a well-recognized occurrence. The Swan-Ganz catheter (SGC) is the one that knots most commonly. A case of a knotted SGC is described in a patient with a persistent left-sided superior vena cava, and we propose that the presence of a left-sided superior vena cava is a risk factor for knot formation not previously reported. We review the published work on the risk factors for knot formation and on the techniques used to remove knotted SGC. We describe a technique using a gooseneck snare and Omni Flush catheter (Angiodynamics, Queensbury, NY, USA) to loosen and untie a knotted SGC.
Subject(s)
Catheterization, Swan-Ganz/adverse effects , Foreign Bodies/therapy , Vena Cava, Superior/abnormalities , Adult , Device Removal , Female , Foreign Bodies/diagnostic imaging , Humans , Radiography , Vena Cava, Superior/diagnostic imagingABSTRACT
A pulsed-leak valve that allows the introduction of a prolonged, flat, and controllable pulse of gas is described. Test results from the valve that utilized a Fourier transform ion cyclotron resonance mass spectrometer with Ar and C2H6 as the sample gases indicate that the valve functions as expected and yields basically rectangular pressure profiles in the cell region. The rise and fall times are similar to those of just the stand-alone pulsed valve and are believed to be determined mainly by the design of the vacuum system, rather than the design of the pulsed-leak valve. Kinetic data for the reaction of Nb(+) with C2H6, acquired with the use of the pulsed-leak valve to introduce the C2H6 gas, demonstrates the practical application of this valve for kinetic and other analogous studies. Use of the pulsed-leak valve greatly reduces the loss of the reactant ion signal during the cooling period.
