BACKGROUND Implanted intravenous infusion port(TIAP)is mainly used for patients who need central venous infusion and poor peripheral vascular conditions.With the advantages of easy to carry,long maintenance cycle,few ...BACKGROUND Implanted intravenous infusion port(TIAP)is mainly used for patients who need central venous infusion and poor peripheral vascular conditions.With the advantages of easy to carry,long maintenance cycle,few complications and excellent quality of life,it has been widely used in the fields of malignant tumor chemotherapy,parenteral nutrition support and repeated blood collection.Implanted intravenous infusion port(IVAP)dislocation can have significant complications if not recognised and reinstated immediately.CASE SUMMARY A 24-year-old man was treated with adjuvant chemotherapy for osteosarcoma.Severe displacement of IVAP catheter was found by chest X-ray examination.The IVAP cannot be used normally.Therefore,we conducted an emergency procedure to reset the catheter through double pigtail catheters,the operation was successful and the infusion port was restored.CONCLUSION When IVAP catheter displacement cannot be reset by conventional techniques,two pigtail catheters can be successfully used instead.展开更多
Efferent loop syndrome is a very rare postgastrectomy syndrome that can occur following Billroth-Ⅱor Rouxen-Y reconstruction.The most common loop syndrome after gastric surgery is afferent loop syndrome;however,effer...Efferent loop syndrome is a very rare postgastrectomy syndrome that can occur following Billroth-Ⅱor Rouxen-Y reconstruction.The most common loop syndrome after gastric surgery is afferent loop syndrome;however,efferent loop syndrome has been reported in rare cases.Here,we report a case of efferent loop obstruction that occurred after postoperative adhesiolysis of a small-bowel obstruction.The patient had undergone a partial gastrectomy with BillrothⅡanastomosis and gastric ulcer perforation 30 years prior.The efferent loop obstruction was successfully resolved by the insertion of a double pigtail stent.To the best of our knowledge,this is the first case in the literature describing the treatment of efferent loop obstruction.展开更多
BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration o...BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration of the catheter of an IVAP via internal jugular vein represents a very rare but potentially severe condition.CASE SUMMARY A 43-year-old woman was identified with a spontaneous fracture and migration of catheter of an IVAP via right internal jugular vein after adjuvant chemotherapy for left breast cancer.A computed tomography showed the fractured catheter of the IVAP in the pulmonary artery.Therefore,we conducted an emergency procedure to remove the catheter fragment by a pigtail catheter combined with a gooseneck trap.CONCLUSION When the fractured catheter of an IVAP was detected,the special shape of the pigtail catheter in combination with the gooseneck trap successfully facilitated the removal of the dislodged catheter.展开更多
BACKGROUND The migration rate of fully covered self-expandable metal stents(FCSEMSs) has been reported to be between 14% to 37%. Anchoring of FCSEMSs using a doublepigtail plastic stent(DPS) may decrease migration.AIM...BACKGROUND The migration rate of fully covered self-expandable metal stents(FCSEMSs) has been reported to be between 14% to 37%. Anchoring of FCSEMSs using a doublepigtail plastic stent(DPS) may decrease migration.AIM To compare stent migration rates between patients who received FCSEMS alone and those who received both an FCSEMS and anchoring DPS.METHODS We conducted a retrospective analysis of endoscopy reporting system and medical records of 1366 patients who underwent endoscopic retrograde cholangiopancreatography(ERCP) with FCSEMS placement at the University of Kentucky health care. Between July 2015 and April 2017,203 patients with FCSEMS insertion for the treatment of malignant biliary stricture,benign biliary stricture,post-sphincterotomy bleeding,bile leak,and cholangitis drainage were identified. The review and analysis were conducted through our endoscopy reporting system(ProVation~? MD) and medical records. Categorical data were analyzed using Chi-Square and Fischer exact test and continuous data using nonparametric tests. A regression analysis was performed to identify factors independently associated with increased risk of stent migration. We determinedan FCSEMS migration endoscopically if the stent was no longer visible in the major papilla.RESULTS1366 patients had undergone ERCP by three advanced endoscopists over 21-mo period; among these,203 patients had FCSEMSs placed. 65 patients had FCSEMSs with DPS,and 138 had FCSEMSs alone. 65 patients had FCSEMSs with DPS,and 138 had FCSEMSs alone. 95 patients had a malignant stricture,82 patients had a benign stricture,12 patients had bile leak,12 patients had cholangitis,and nine patients had post-sphincterotomy bleeding. The migration rate in patients with anchored FCSEMSs with DPS was 6%,and those without anchoring DPS was 10%(P = 0.35). Overall,migration was reported in 18 patients with FCSEMSs placement out of 203 patients with an overall migration rate of 9.7%. There was no significant association between anchoring the FCSEMSs with DPS and the risk of stent migration. Only patients with the previous sphincterotomy and begin biliary stricture were found to have a statistically significant difference in the migration rate between patients who had FCSEMS with DPS and FCSEMS alone(P = 0.01).CONCLUSION The risk of migration of biliary FCSEMS was 9.7 %. Anchoring an FCSEMS with DPS does not decrease the risk of stent migration.展开更多
Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old wom...Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old woman, presented with hematemesis and obstructive jaundice. Ruptured hepatic arterial pseudoaneurysm was diagnosed, which was suspected to have been caused by long-term placement of an endoscopic retrograde biliary drainage(ERBD) stent. This episode of biliary bleeding was successfully treated by transarterial embolization(TAE). Pseudoaneurysm leading to hemobilia is a rare but potentially fatal complication in patients with long-term placement of ERBD. TAE is a minimally invasive procedure that offers effective treatment for biliary bleeding.展开更多
Objective To observe the effect of drainage of pericardium with pigtail tube associated with drainage tube or puncture of pleural cavity. Method Saving cardiac tamponade and treating serious multiple serous cavity inf...Objective To observe the effect of drainage of pericardium with pigtail tube associated with drainage tube or puncture of pleural cavity. Method Saving cardiac tamponade and treating serious multiple serous cavity inflammation through percutaneous catheterization with pigtail tube infra-xiphoid associating with percutaneous drainage tube or puncture and chemotherapy. Resutls The 4 cases of patients with serous poly serous cavity inflammation were all cured on the whole. They were all not only lived fro 4-6 months longer, but also got better existing mass and they could live on themselves. Conclusion It is a good way to cure patients with serious poly serous cavity inflammation of percutaneous catheterizatin with pigtail tube infra-xiphoid associating with percutaneous drainage tube or puncture and chemotherapy. It can also save pericardiac tamponade patients.It is worth application in clinic.展开更多
Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a w...Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.展开更多
基金Supported by Shenzhen Key Medical Discipline Construction Fund,No.SZXK052。
文摘BACKGROUND Implanted intravenous infusion port(TIAP)is mainly used for patients who need central venous infusion and poor peripheral vascular conditions.With the advantages of easy to carry,long maintenance cycle,few complications and excellent quality of life,it has been widely used in the fields of malignant tumor chemotherapy,parenteral nutrition support and repeated blood collection.Implanted intravenous infusion port(IVAP)dislocation can have significant complications if not recognised and reinstated immediately.CASE SUMMARY A 24-year-old man was treated with adjuvant chemotherapy for osteosarcoma.Severe displacement of IVAP catheter was found by chest X-ray examination.The IVAP cannot be used normally.Therefore,we conducted an emergency procedure to reset the catheter through double pigtail catheters,the operation was successful and the infusion port was restored.CONCLUSION When IVAP catheter displacement cannot be reset by conventional techniques,two pigtail catheters can be successfully used instead.
文摘Efferent loop syndrome is a very rare postgastrectomy syndrome that can occur following Billroth-Ⅱor Rouxen-Y reconstruction.The most common loop syndrome after gastric surgery is afferent loop syndrome;however,efferent loop syndrome has been reported in rare cases.Here,we report a case of efferent loop obstruction that occurred after postoperative adhesiolysis of a small-bowel obstruction.The patient had undergone a partial gastrectomy with BillrothⅡanastomosis and gastric ulcer perforation 30 years prior.The efferent loop obstruction was successfully resolved by the insertion of a double pigtail stent.To the best of our knowledge,this is the first case in the literature describing the treatment of efferent loop obstruction.
文摘BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration of the catheter of an IVAP via internal jugular vein represents a very rare but potentially severe condition.CASE SUMMARY A 43-year-old woman was identified with a spontaneous fracture and migration of catheter of an IVAP via right internal jugular vein after adjuvant chemotherapy for left breast cancer.A computed tomography showed the fractured catheter of the IVAP in the pulmonary artery.Therefore,we conducted an emergency procedure to remove the catheter fragment by a pigtail catheter combined with a gooseneck trap.CONCLUSION When the fractured catheter of an IVAP was detected,the special shape of the pigtail catheter in combination with the gooseneck trap successfully facilitated the removal of the dislodged catheter.
文摘BACKGROUND The migration rate of fully covered self-expandable metal stents(FCSEMSs) has been reported to be between 14% to 37%. Anchoring of FCSEMSs using a doublepigtail plastic stent(DPS) may decrease migration.AIM To compare stent migration rates between patients who received FCSEMS alone and those who received both an FCSEMS and anchoring DPS.METHODS We conducted a retrospective analysis of endoscopy reporting system and medical records of 1366 patients who underwent endoscopic retrograde cholangiopancreatography(ERCP) with FCSEMS placement at the University of Kentucky health care. Between July 2015 and April 2017,203 patients with FCSEMS insertion for the treatment of malignant biliary stricture,benign biliary stricture,post-sphincterotomy bleeding,bile leak,and cholangitis drainage were identified. The review and analysis were conducted through our endoscopy reporting system(ProVation~? MD) and medical records. Categorical data were analyzed using Chi-Square and Fischer exact test and continuous data using nonparametric tests. A regression analysis was performed to identify factors independently associated with increased risk of stent migration. We determinedan FCSEMS migration endoscopically if the stent was no longer visible in the major papilla.RESULTS1366 patients had undergone ERCP by three advanced endoscopists over 21-mo period; among these,203 patients had FCSEMSs placed. 65 patients had FCSEMSs with DPS,and 138 had FCSEMSs alone. 65 patients had FCSEMSs with DPS,and 138 had FCSEMSs alone. 95 patients had a malignant stricture,82 patients had a benign stricture,12 patients had bile leak,12 patients had cholangitis,and nine patients had post-sphincterotomy bleeding. The migration rate in patients with anchored FCSEMSs with DPS was 6%,and those without anchoring DPS was 10%(P = 0.35). Overall,migration was reported in 18 patients with FCSEMSs placement out of 203 patients with an overall migration rate of 9.7%. There was no significant association between anchoring the FCSEMSs with DPS and the risk of stent migration. Only patients with the previous sphincterotomy and begin biliary stricture were found to have a statistically significant difference in the migration rate between patients who had FCSEMS with DPS and FCSEMS alone(P = 0.01).CONCLUSION The risk of migration of biliary FCSEMS was 9.7 %. Anchoring an FCSEMS with DPS does not decrease the risk of stent migration.
基金Supported by Japanese Red Cross Kyoto Daiichi Hospital,Kyoto,Japan
文摘Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old woman, presented with hematemesis and obstructive jaundice. Ruptured hepatic arterial pseudoaneurysm was diagnosed, which was suspected to have been caused by long-term placement of an endoscopic retrograde biliary drainage(ERBD) stent. This episode of biliary bleeding was successfully treated by transarterial embolization(TAE). Pseudoaneurysm leading to hemobilia is a rare but potentially fatal complication in patients with long-term placement of ERBD. TAE is a minimally invasive procedure that offers effective treatment for biliary bleeding.
文摘Objective To observe the effect of drainage of pericardium with pigtail tube associated with drainage tube or puncture of pleural cavity. Method Saving cardiac tamponade and treating serious multiple serous cavity inflammation through percutaneous catheterization with pigtail tube infra-xiphoid associating with percutaneous drainage tube or puncture and chemotherapy. Resutls The 4 cases of patients with serous poly serous cavity inflammation were all cured on the whole. They were all not only lived fro 4-6 months longer, but also got better existing mass and they could live on themselves. Conclusion It is a good way to cure patients with serious poly serous cavity inflammation of percutaneous catheterizatin with pigtail tube infra-xiphoid associating with percutaneous drainage tube or puncture and chemotherapy. It can also save pericardiac tamponade patients.It is worth application in clinic.
文摘Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.
