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A Tringali

Publications and source records attributed to A Tringali.

12 recordsLinked to original sources
PubMed2004

Therapeutic biliary endoscopy.

Almost all biliary diseases are now amenable to endoscopic treatment. Progress in therapeutic biliary endoscopy is currently focusing on identifying the best treatment options to be used in each case in relation to the available evidence: how should a malignant stricture of the common bile duct or hilum be drained? How should an external biliary fistula be treated? What should one do with the gallbladder after extraction of common bile duct stones? Should sedation or general anesthesia be offered? Progress has been made in the technique of endoscopic ampullectomy and in developing new devices to improve the success rate of endoscopic retrograde cholangiopancreatography.

Acute Disease↗
PubMed2004

Hemosuccus pancreaticus secondary to intraductal rupture of a primary splenic artery aneurysm: diagnosis by ERCP and successful management by interventional radiology.

This report describes the case of a 65-year-old man with a prolonged history of gastrointestinal bleeding of unknown origin. During a 2-year period, he underwent 28 endoscopic procedures, three angiographies with or without heparin provocation, a nuclear scan, and abdominal magnetic resonance imaging, none of which were diagnostic. A blind ileocecal resection was also carried out. A diagnosis of hemosuccus pancreaticus secondary to a ruptured primary splenic artery aneurysm was obtained by endoscopic retrograde cholangiopancreatography, and successful interventional radiographic embolization of the splenic artery aneurysm was conducted. During a 17-month follow-up period, no relapse of gastrointestinal bleeding was observed.

Aged↗
PubMed2004

External pancreatic fistulas resistant to conventional endoscopic therapy: endoscopic closure with N-butyl-2-cyanoacrylate (Glubran 2).

External pancreatic fistulas may follow abdominal surgery or injury. While most respond to conservative management or endoscopic intervention, others might require surgery for complete healing. We report four cases of patients with external pancreatic fistulas that failed to respond to conservative management and drainage. N-butyl-2-cyanoacrylate surgical glue (Glubran 2) was directly injected into the fistulous tract. The fistulas closed within 24 hours of the Glubran 2 injection in three cases (75 %). In patients with external pancreatic fistulas that fail to respond to conservative and endoscopic drainage, injection of Glubran 2 directly into the fistulous tract may lead to closure, thus avoiding the need for surgical intervention.

Adult↗
PubMed2003

Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures.

BACKGROUND: High stent cost is considered the major drawback of self-expanding metal stents for dysphagia palliation in patients with inoperable esophageal strictures. We report our experience with a self-expanding plastic (Polyflex) stent, the cost of which is half that of the metal stents. METHODS: Between September 1999 and April 2001, 16 dysphagic patients (15 men; mean age, 69.4 +/- 14.5 years; range, 49-100 years; mean dysphagia score, 3.31 +/- 0.6) with esophageal strictures who underwent Polyflex stent placement (insertion device diameter, 12-14 mm; postexpansion inner stent diameter, 16-21 mm; stent length, 9, 12, and 15 cm) were studied prospectively. The strictures were caused by postsurgical recurrence of gastric/esophageal cancer at the anastomotic site in five patients, primary esophageal cancer in four patients, esophagocardia junction cancer in four patients, metastatic mediastinal lymph nodes from a primary lung cancer invading the esophagus in 1 patient, and benign peptic stricture in two elderly patients. All the patients were prospectively followed until death. RESULTS: Stent insertion was technically successful in 12 patients (75%). Stent placement failed in four patients (25%) because of failure to pass the delivery catheter across the stricture in three patients and failure of the stent to open in one patient. Early and late stent migration occurred in two patients and 1 patient, respectively. Tumor overgrowth occurred in 1 patient. The mean dysphagia score 7 days after stent placement was 1.1 +/- 0.9. Mean survival was 100.6 +/- 71.2 days (range, 8-225 days). CONCLUSION: Self-expanding Polyflex stents are safe and effective for inoperable esophageal strictures and have an acceptable technical success rate. Further experience, better selection criteria, and design improvements should improve results.

Aged↗
PubMed2003

Comparison of standard and steerable catheters for bile duct cannulation in ERCP.

BACKGROUND AND STUDY AIMS: The aim of the study was to compare two steerable endoscopic retrograde cholangiopancreatography (ERCP) catheters with regard to speed and safety in cannulating the common bile duct. PATIENTS AND METHODS: A standard cannula, a short-nosed sphincterotome, and a bendable catheter were used. At two tertiary centres, a total of 312 patients were randomly assigned to receive treatment with one of three catheters and either by a trainee or an expert endoscopist. When cannulation failed, a further attempt was made with a different catheter. If this failed, a change in operator or other manoeuvres followed. The following were assessed: time to cholangiography and deep cannulation, number of attempts and success rates of cannulation, number of pancreatic duct injections, success of catheter cross-over, and complication rates. RESULTS: Both steerable catheters were significantly better for the initial cholangiogram than the standard catheter (standard catheter 75 %, bendable catheter 84 %, sphincterotome 88 %; P = 0.038), with no significant differences between the bendable catheter and the sphincterotome. Both were also better for deep cannulation of the bile duct (standard cannula 66 %, bendable catheter 69 %, sphincterotome 78 %; P = 0.15). When the standard catheter failed, a steerable catheter succeeded in 26 % of cases. Trainees experienced greater benefit from using steerable catheters. For experts, the bendable catheter was the quickest to achieve cholangiography and deep cannulation. Further manoeuvres had an 85-90 % success rate in allowing biliary access. Twenty of 23 needle-knife papillotomies (87 %) were successful when other methods had failed. The overall ERCP success rate was 97 %. Pancreatitis occurred in 5.3 % of cases. CONCLUSIONS: Steerable catheters allow faster access and can succeed when a standard catheter fails. If cannulation is difficult, changing the catheter should be considered at an early stage. Needle-knife papillotomy is a successful technique in expert hands.

Adult↗
PubMed2003

A prospective, randomized multicenter trial comparing DoubleLayer and polyethylene stents for malignant distal common bile duct strictures.

BACKGROUND AND STUDY AIMS: Endoscopic biliary stenting is an established treatment for malignant obstructive jaundice. Stent clogging continues to be a major problem with plastic stents. The aim of this study was to carry out a prospective comparison of two stents with different materials and shapes: the Olympus DoubleLayer stent (DLS; perfluoro alkoxy, without sideholes) and the standard polyethylene (PE) stent (with sideholes). PATIENTS AND METHODS: A total of 120 patients (70 women; mean age 71, range 36 - 91) with jaundice due to malignant strictures of the middle to distal third of the common bile duct were randomly assigned to receive either DLS (n = 60) or PE (n = 60) biliary stents. Patients with cholangitis, hemobilia, previous biliary drainage, hilar stricture, or ampullary cancer were excluded. RESULTS: In all, 28 DLS patients (47 %) and 17 PE stent patients (29 %) died without clinical evidence of stent occlusion after a mean of 114 and 105 days, respectively ( P < 0.05). Twenty-six DLS patients (43 %) and 38 PE stent patients (63 %) had symptoms of stent clogging after a mean of 144 and 99 days, respectively ( P < 0.05). Stent dysfunction (stent orifice impacted on the bile duct or duodenal wall, stent migration) was recorded in six DLS patients (10 %) and five PE patients (8 %) (n. s.). Kaplan-Meier analysis of DLS and PE stent clogging-free survival showed a significantly longer patency period with the DLS stents (P = 0.0005). CONCLUSIONS: These results show that DoubleLayer stents have a longer patency period than PE stents. Patients who received PE stents had a higher risk of stent occlusion (relative risk 3.05; 95 % CI, 1.57 - 5.89) before death than DLS patients.

Adult↗
PubMed2002

Endoscopic palliation of unresectable malignant oesophageal strictures with self-expanding metal stents: comparing Ultraflex and Esophacoil stents.

BACKGROUND: Two types of self-expanding metal stents to palliate dysphagia in patients with unresectable malignant oesophageal strictures have been compared. METHODS: From February 1996 to October 2000, 50 metal stents (23 covered Ultraflex and 27 Esophacoil) were placed in 50 patients (40 males, mean age: 67+/-12 years, range: 33-100, mean dysphagia score: 3.18+/-0.66) with unresectable malignant oesophageal strictures. Patients were followed until death. A retrospective review has been made of a prospectively collected database. RESULTS: The two groups were comparable as far as concerns degree of dysphagia, location and stricture length. Stent placement was successful in all cases. Covered Ultraflex stent was placed in 2 patients with oesophagobronchial fistula. No procedure-related deaths were seen. Early severe complications occurred in 2 patients (perforation in 1 and tumour bleeding in 1, in the Esophacoil group). Nine patients and 1 patient complained of pain following Esophacoil and Ultraflex stent placement, respectively. Late complications were asymptomatic rupture of distal Esophacoil rings in 2 patients, symptomatic Ultraflex stent migration in 2 and tumour overgrowth in 3 (Esophacoil 1, Ultraflex 2). Mean dysphagia score at 4 weeks after stent placement was 1.9+/-0.77. Mean survival was 177+/-109 days (range: 35-603 days). There were no significant differences in technical success, dysphagia palliation, complications (except chest pain) and survival using the two types of stent. CONCLUSIONS: Self-expanding metal stents are safe with high technical success and achieve satisfactory long-term palliation for dysphagia. The covered Ultraflex and Esophacoil stents are equally effective.

Aged↗
PubMed2002

Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence.

BACKGROUND AND STUDY AIMS: There have been growing concerns about the long-term sequelae of endoscopic sphincterotomy (ES). The aims of the study were to evaluate the long-term clinical outcome of ES for choledocholithiasis and to identify the predictors of recurrence. PATIENTS AND METHODS: A total of 529 patients (233 men, 296 women; mean age 63, range 9 - 88) who underwent successful ES for choledocholithiasis were evaluated. Follow-up data were obtained retrospectively. Statistical analyses were carried out for 334 patients who had a follow-up of at least 5 years or had recurrence. RESULTS: Immediate complications occurred in 37 patients (7 %). Follow-up data were available in 458 patients (86.6 %), of whom 280 (61.1 %) were asymptomatic, 127 (27.7 %) died from unrelated causes without recurrence, and 51 (11.1 %) had biliary symptoms and/or choledocholithiasis recurrence. Most recurrences (65 %) occurred more than 2 years following ES and were observed on multiple occasions in 13 patients (2.8 %). A bile duct diameter of 22 mm or greater was found to predict recurrence. Of 190 patients with an intact gallbladder, 11 (5.8 %) developed acute cholecystitis necessitating emergency cholecystectomy; all of these had previously documented gallstones. CONCLUSIONS: Endoscopic sphincterotomy for choledocholithiasis is found to be safe at long-term follow-up. A dilated bile duct (> or = 22 mm) is a marker for patients at increased risk of recurrence of symptoms and/or choledocholithiasis.

Adolescent↗
PubMed2000

ED "hold" patients: is their care also being held?

INTRODUCTION: Patient care should be governed by the same standards of care regardless of location within a hospital system. Little is known about adherence to standards of care for admitted patients who are "held" in the emergency department because of an unavailable inpatient bed. For example, is there a difference in the timeliness of nursing assessments and initial antibiotic administration for patients with pneumonia who are held in the emergency department compared with those who are directly admitted to an inpatient bed? METHODS: A descriptive comparison research design with 2 known groups ("ED hold" patients and "ED direct-admit" patients) was used. A convenience sample of 104 closed medical records was obtained from a Midwestern hospital for a retrospective chart audit. RESULTS: Patients held in the emergency department had their blood pressure, pulse, respiratory rate, and oxygen saturation recorded with greater frequency compared with patients who were directly admitted. Directly admitted patients had their intake and output and their temperature noted with greater frequency. Although there was no statistically significant difference in the timeliness of respiratory assessments or antibiotic administration, antibiotics were delivered to the ED direct-admit group an average of 1 hour earlier than to the ED hold group. DISCUSSION: When measuring only the frequency and/or timeliness of taking vital signs, recording intake and output, and administering antibiotics, there were statistical differences between "hold" patients and "direct-admit" patients. In some instances, ED "hold" patients actually received more timely assessment than did "direct-admit" patients. Direct-admit patients received antibiotics an average of 1 hour sooner. More studies are necessary to evaluate other aspects of care that may or may not be compromised when admitted patients are "held" in the emergency department.

Aged↗
PubMed1999

Mechanical properties of smooth muscle portal vein in normal and dystrophin-deficient (mdx) mice.

Mechanical properties of the vascular smooth muscle from normal and dystrophin-deficient (mdx) mice were examined. Changes in resting and developed tensions in response to stretch were recorded in isolated portal vein. The vascular segments were elongated in 5 % increments of the 'in situ' length (Lr) up to 1.30Lr. The resting length-tension curves in male mdxmice were similar to normal mice, while a marked decrease in the slope of the curve was noted in female mdx mice. These findings were not affected by atropine, phentolamine, tetrodotoxin or [Ca2+] in the surrounding media. At Lr, the tension of isolated portal vein was characterized by spontaneous synchronized uniform force waves in normal mouse. In contrast, in mdxmouse portal veins an irregular motor pattern characterized by desynchronized force waves with a decrease of amplitude and an increase in frequency was recorded. Extension of the length of the portal vein segment did not increase the spontaneous phasic activity developed in female mdx mice although this was noted with male mdx mice and normal mice. Experiments with chemical depolarizing agents indicated that spontaneous myogenic excitation activated the great majority of vascular smooth muscle cells in normal mouse portal vein, whereas in mdx mice only a reduced number of these cells were excited suggesting that in the mdx mouse the intercellular electronic coupling is altered. In conclusion this study provides the first description of the mechanical activities of portal vein longitudinal muscle and shows that in mdx mice the motor activity is severely disrupted.

Acetylcholine↗