Treatment of colonic obstructions with metallic stents: indications, technique, and complications.
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Aged↗
Biomedical subjects
M Maynar
Publications and source records attributed to M Maynar.
Transjugular intrahepatic portosystemic shunt versus sclerotherapy in the elective treatment of variceal hemorrhage.
BACKGROUND & AIMS: Uncontrolled studies suggest that placement of a transjugular intrahepatic portosystemic shunt (TIPS) could be useful in the treatment of variceal bleeding. The aim of this study was to evaluate the efficacy and safety of TIPS in the elective treatment of hemorrhage from esophageal varices in a randomized controlled study that compared the effects of TIPS with those of endoscopic sclerotherapy (ES). METHODS: Sixty-three consecutive cirrhotic patients with hemorrhage from esophageal varices were included. Thirty-two patients were randomly allocated to ES and 31 to TIPS groups. RESULTS: One patient in each group died before the therapeutic procedure could be performed. During a mean follow-up period of 15 months, variceal rebleeding occurred in 51.6% of the patients in the ES group and 23% of those in the TIPS group. Uncontrolled rebleeding occurred in 10 of 31 patients in the ES group, whereas rebleeding did not occur in any patient of the TIPS group. Hepatic encephalopathy was more frequent in TIPS patients (33.3%) than in those treated by ES (13%). However, mortality was similar in both treatment groups. CONCLUSIONS: These preliminary results suggest that TIPS is more effective than ES in the prevention of variceal rebleeding in cirrhotic patients, even though no difference in survival was observed.
Adult↗
Effects of a long-term training program of increasing intensity on the immune function of indoor Olympic cyclists.
We have studied, on blood samples, the level of immunocompetence (concentration of immune cells, phagocytic process of polymorphonuclear neutrophils, proliferative response of lymphocytes to mitogens), the ascorbic acid content of such immunocompetent cells and the "stress hormone" status (cortisol, ACTH and beta-endorphin) of 10 cyclists, members of the Spanish Indoor Olympic Team and participants in the Olympic Games of Barcelona '92. The study was performed twice during their training for such an event: during the third year of the program (February, 1991) and immediately before the Games (June, 1992). As regards the phagocytic process of neutrophils, we studied the different steps of this process: adherence to endothelium, directed mobility or chemotaxis, ingestion of latex beads and superoxide anion production measured by the nitroblue tetrazolium (NBT) reduction test. We observed a statistically significant increase in chemotaxis and NBT reduction activity just before the Games as compared to the third year of the program, whereas variations were not found in the other parameters. The values of the proliferative capacity of lymphocytes were slightly higher in June '92 than in February '91, but no statistically significant differences were found. The ascorbic acid content decreased strikingly (especially in lymphocytes) immediately before the Games. Regarding the stress hormones and neuropeptides (cortisol, ACTH and beta-endorphin), we observed an increase in serum ACTH and beta-endorphin levels in the last determination (June '92) in comparison to the first one (February '91). These results suggest that, at the end of a long-term training program. no immunosuppression occurs, although an important increase in the concentration of stress hormones (ACTH and beta-endorphin) is found. This is probably caused by the psychological stress associated to the participation in such an important event as the Olympic Games.
Adrenocorticotropic Hormone↗
Effects of physical exercise on some parameters of bone metabolism in postmenopausal women.
This study was performed on 19 postmenopausal female volunteers in a period of five months of moderate physical exercise in order to examine beneficial changes in muscle strength and flexibility as well as changes in sex hormone binding globulin (SHBG) and other parameters related to bone metabolism. While SHBG decreased significantly (from 56.0 +/- 20.0 to 43.9 +/- 16.1 nM, P = 0.009) phosphorus and urea increased (from 2.8 +/- 0.4 to 4.0 +/- 0.5 mg/dl, P = 0.00006 and from 32.1 +/- 9.4 to 42.3 +/- 11.0 mg/dl, P = 0.03, respectively). These changes were accompanied by significant increases in muscle strength and flexibility. Other parameters such as alkaline phosphatase and calcium did not change significantly during the study. Plasma levels of SHBG were negatively correlated with phosphorus. As higher SHBG has been related to increased bone loss in older women, we conclude that moderate physical activity is an effective means to preserve bone loss in postmenopausal women.
Alkaline Phosphatase↗
Changes in plasma enzyme activities in professional racing cyclists.
OBJECTIVE: To reports changes in plasma levels in professional racing cyclists. METHODS: Plasma levels of the intracellular enzymes aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, lactate dehydrogenase, and alkaline phosphatase were measured resting and after exercise in professional cyclists participating in two road races: Vuelta Ciclista a Valencia (800 km, beginning of the cyclist season), and the top rank race Vuelta a España (2700 km, at the end of cyclist season). RESULTS: A significant increase in plasma aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase was observed at the end of the race over the corresponding paired start values (P < 0.05). The increase in plasma lactate dehydrogenase after the race was only statistically significant (P < 0.05) in the Vuelta a España. The longer the duration of the cycle tour race, the greater were the increases in aspartate aminotransferase and alanine aminotransferase levels. The high levels returned to their start values during the overnight resting period. CONCLUSIONS: The presence of these enzymes in the blood is probably due to mechanically damaged muscle cells leaking their contents into the interstitial fluid.
Alanine Transaminase↗
Colorectal obstruction: treatment with metallic stents.
PURPOSE: To evaluate the usefulness of self-expandable metallic stents in the treatment of acute colonic obstruction secondary to colorectal neoplasm. MATERIALS AND METHODS: Stents were placed in 12 patients with clinical and radiologic signs of acute colonic obstruction. After symptom improvement, patients underwent radiologic staging. Single-stage surgery was performed in patients without disseminated disease. RESULTS: Stent placement was successful in all patients. Signs and symptoms of intestinal obstruction resolved within 24 hours of stent placement in 10 patients (83%). In two patients with massive bowel dilation, improvement was evident 2 and 4 days after stent placement. Ten patients underwent elective single-stage surgery with partial colonic resection and creation of a primary end-to-end anastomosis without major complications. In two patients with disseminated neoplastic disease, stent placement was considered the primary palliative treatment. CONCLUSION: Metallic stent placement to relieve acute colonic obstruction secondary to colorectal carcinoma is a safe therapeutic alternative, allowing single-stage surgery in suitable cases. In patients who are not surgical candidates it is an adequate palliative option.
Acute Disease↗
Percutaneous treatment of aortoiliac atherosclerosis: a case report.
This case report describes the current usage of percutaneous techniques in the treatment of aortoiliac atherosclerotic disease. The kissing balloon technique was utilized to perform percutaneous transluminal angioplasty of the distal aorta and its bifurcation. Subsequently, bilateral vascular stents were placed extending from the common iliac arteries into the aorta. Following stenting and percutaneous transluminal angioplasty, angiography demonstrated excellent blood flow in the aorta and iliac vessels. Palpable distal pulses were restored, and the patient's symptoms were alleviated. Percutaneous revascularization techniques offer an alternative to surgery in the treatment of selected patients with stenotic aortoiliac disease.
Angioplasty, Balloon↗
Urine excretion of androgen hormones in professional racing cyclists.
This study was performed on 16 professional racing cyclists to examine changes in urine concentrations of androgen hormones (testosterone, epitestosterone, androsterone, etiocholanolone, 11-hydroxy-androsterone and 11-hydroxy-etiocholanolone) and plasma sex hormone binding globulin (SHBG) after training and after competition. The urinary concentrations of androgen hormones decreased during the period of training and increased during competition, this being the reverse of what happened to SHBG plasma concentrations. These changes would suggest that physical activity may have an influence on the elimination of androgen hormones and on the synthesis of its transporting protein SHBG.
Androgens↗
Intraureteral metallic self-expanding endoprosthesis (Wallstent) in the treatment of difficult ureteral strictures.
Intractable and recurrent ureteral stricture presents a continuous challenge to the urologist. We report on 5 patients with severe ureteral stricture who were successfully treated with self-expanding metallic stents. Ureteral stricture occurred at ureteroileal anastomotic sites after neoplasm resection in 2 cases, multiple upper ureteral strictures were related to multiple surgical procedures for correction of bladder exstrophy in 1 and a ureteral kink developed in 1. Treatment with transluminal balloon dilation provided poor results but self-expanding metallic stents were used successfully with no major complications. In the last patient the stent and the overlying ureter were removed due to recurrent reflux; the gross and histological ureteral changes are discussed in detail. The technical approach is described, alternative therapeutic options are considered and pertinent literature is reviewed.
Adult↗
[Self-expandable metal prostheses. A new alternative palliative therapy of malignant stenotic lesions of the esophagus].
The treatment of malignant esophageal stenoses is a serious problem which may have a surgical solution at diagnosis in only a selected number of cases. Chemotherapy and radiotherapy are the main palliative treatments; surgery has a high morbidity and mortality rate. The insertion of esophageal prostheses could be an alternative palliative treatment. From January 1991 to November 1993, 41 autoexpandable metallic prostheses (12 Wallstent type, 19 Strecker type and 1 Rosch-Uchida type) have been implanted in 30 patients with esophageal cancer one with lung cancer and two with radiation induced esophagitis. Technical success resulted in 28 patients; an initial failure requiring a new prosthesis insertion occurred in 5 patients. Technical aspects and results are analyzed.
Adenocarcinoma↗
Stimulation of the phagocytic function of neutrophils in sedentary men after acute moderate exercise.
All the different stages of phagocytic function in blood polymorphonuclear neutrophils of sedentary (untrained) young men before, immediately after, and 15 min after being subjected to submaximal acute moderate exercise (50% maximal oxygen uptake) on a cycle ergometer were studied. No statistically significant differences were found in adherence or microbicide capacity against Candida albicans immediately after physical exercise. However, spontaneous mobility, chemotaxis and attachment and phagocytosis of Candida albicans at 15 min of incubation were significantly stimulated. Fifteen minutes after exercise spontaneous mobility, chemotaxis, and attachment of Candida albicans had returned to basal values, while phagocytosis of Candida albicans remained higher than basal values. One can, therefore, conclude that acute moderate exercise stimulates the phagocytic capacity of neutrophils in sedentary young men. In addition, no differences were found in the plasma adrenocorticotropic hormone concentration after exercise. However, immediately after exercise there was a decrease in the serum cortisol concentration, which had returned to basal 15 min later.
Adrenocorticotropic Hormone↗
Transjugular intrahepatic portosystemic shunt: early experience with a flexible trocar/catheter system.
OBJECTIVE: The purpose of this study was to determine the feasibility of using a flexible trocar/catheter system to create a transjugular intrahepatic portosystemic shunt (TIPS). SUBJECTS AND METHODS: A flexible needle/trocar was used to connect the hepatic vein to the portal vein in 23 patients with portal hypertension and a history of bleeding gastroesophageal varices. Five patients had signs and symptoms of encephalopathy before shunting; in four, the disease was classified as Child's class C and in one, as Child's class B. Nine-millimeter self-expandable metallic stents were used in all patients. RESULTS: The procedure was technically successful in all patients. The mean portosystemic pressure gradient decreased from 26 to 16 mm Hg (range, 7-23 mm Hg). Eight patients have died. One patient in a hepatic coma with hepatorenal failure survived percutaneous portosystemic shunting, but died 2 days after the TIPS procedure was done. After creation of the shunt, three other patients died of unrelated disease without recurrence of bleeding from gastroesophageal varices. Two patients died of massive bleeding from esophageal varices, one 24 hr after shunting and one of disseminated intravascular coagulation after a second attempt to establish a shunt. One patient died of sepsis associated with infected ascitic fluid 2 months after the TIPS procedure was done, and one died of unknown causes 4 months after the procedure was done. The mean follow-up time in the surviving 15 patients was 12 months. Seven patients had recurrence of gastrointestinal bleeding; the recurrence was due to a thrombosed shunt in two, to hepatic vein stenosis in four, and to a high portosystemic pressure gradient (22 mm Hg) after creation of the shunt in one. Hepatic vein stenosis was noted on portal venograms in another three otherwise asymptomatic patients. In four of five patients, encephalopathy was adequately controlled after shunting. The fifth patient with encephalopathy (Child's class C) and an additional patient in whom encephalopathy (Child's class C) developed after the TIPS procedure have had two additional hospital admissions because of difficulty in controlling the encephalopathy. The amount of ascitic fluid decreased or totally disappeared after treatment in all cases. No severe complications associated with creation of a TIPS were observed. CONCLUSION: Use of a flexible trocar/catheter system to create a TIPS is a simple, safe, and moderately reliable means of decompressing the portal vein in patients with portal hypertension.
Adult↗
[Hyperkalemia and its electrocardiographic consequences in professional cyclists at the end of a bicycle race].
The plasma potassium levels were measured in 15 cyclists during the "Vuelta Ciclista al País Valenciano" (700 km, 6 days), both at the start and at the end of the last stage. Plasma potassium levels increased from 4.3 +/- 1.9 mmol/l (resting) to 7.3 +/- 3.2 mmol/l at the end of the stage. The increase in plasma potassium levels was related to changes in other plasma electrolyte levels and it led to electrocardiographic T wave and QRS abnormalities.
Bicarbonates↗
Effect of submaximal physical exercise performed by sedentary men and women on some parameters of the immune system.
Submaximal physical exercise by sedentary men and women on a bicycle ergometer for 60 min at 58% (men) and 55% (women) of VO2 max. was evaluated for its effect on the number of total leukocytes (WBC), lymphocytes, monocytes and neutrophils and the percentages of CD3+, CD4+, CD8+ and CD19+ lymphocyte subpopulations, as well as on IgA, IgG and IgM serum immunoglobulin levels as one measure of B-lymphocyte function. Blood samples were collected before, immediately after, and 15 minutes after physical exercise. Exercise did not significantly change the total number of WBC, lymphocytes, monocytes or neutrophils, or the percentages of CD3+, CD4+, CD8+ and CD19+ positive cells and the IgA and Ig M immunoglobulins. However the serum level of IgG immunoglobulins immediately after exercise was significantly lower than both before (p < 0.001) and 15 min later (p < 0.05). No differences in the results between men and women were detected.
Adult↗
Percutaneous embolization of splenic artery pseudoaneurysm as a treatment of hemoperitoneum in a CAPD patient.
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Aneurysm↗
Changes in sex hormone binding globulin, high density lipoprotein cholesterol and plasma lipids in male cyclists during training and competition.
This study was performed on 13 professional race-cyclists to examine changes in sex hormone binding globulin (SHBG), high density lipoprotein cholesterol (HDL-C) and serum lipid concentrations after training and after competition. While SHBG, total cholesterol and phospholipids increased and free fatty acids (FFA) decreased significantly during training, HDL-C and FFA increased and SHBG and triglycerides (TG) decreased significantly during the competition period. These latter changes in serum lipids and lipoproteins were assumed to be a direct effect of utilisation of muscle and plasma TG as fuels for exertion occurring only in extreme exercise. Changes in SHBG concentrations indicated that they were dependent on the conditions of the physical effort and could be related not only to the concentrations of androgens but also to the reduction in body mass.
Adult↗
Intraparenchymal anesthesia infiltration during transjugular intrahepatic portosystemic shunting.
The authors describe a technique for administration of anesthetic to the area of the transparenchymal tract during transjugular percutaneous transhepatic portosystemic shunting. Seven of the eight patients in whom the technique was used did not experience pain during balloon dilation of the tract, and one patient experienced only minimal pain. The technique allows good pain control in patients with severe liver failure and resultant inability of the liver to metabolize pharmaceuticals.
Aged↗
Transcatheter placement of a metallic stent for treatment of an occluded H-graft portacaval shunt.
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Catheterization↗