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ABSTRACT: This study aimed to determine the feasibility of a novel transtracheal endoscopic technique for thoracic and mediastinum evaluation in a canine model.
In two dogs under general anesthesia, a transverse incision was made in the right lateral wall of the lower trachea and used as an entrance for thoracic and mediastinum evaluation.
Transtracheal thoracoscopic evaluation was possible in both animals. One animal experienced massive subcutaneous emphysema immediately after evaluation of the thoracic cavity and required chest tube drainage. The follow-up endoscopies 2 weeks after surgery showed good healing of the tracheal openings in both animals.
The transtracheal approach to the thoracic cavity and mediastinum appears to be feasible. This technique may provide an intriguing platform for the development of natural orifice transluminal surgery (NOTES) in the thoracic cavity.
Surgical Endoscopy 04/2010; 24(11):2905-7. · 4.01 Impact Factor
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ABSTRACT: Because thrombosis and stenosis are the most frequent causes of arteriovenous graft (AVG) failure, several externally supported grafts were designed to enhance incompressibility and kinking resistance to improve the patency. However, consensus on advantage of these modifications having still not been reached might relate to the previous limited patient numbers and small studies. This study analyzed the longevity of externally supported and nonsupported AVG on the basis of the nationwide database to understand whether the externally supported design could improve the duration of patency of AVG.
Adult incident patients (n = 4402) were retrospectively enrolled who had began hemodialysis between January 1, 2002 and December 31, 2005. All incident patients with AVG, before or after beginning regular hemodialysis, between January 1, 2000 and December 31, 2006 were identified. The Cox proportional hazard model was used to compare the longevity of externally supported and nonsupported AVG by controlling other covariates.
There were 990 patients with externally supported AVG and 3412 patients with nonsupported AVG. The patency rates of externally supported AVG were 49.4%, 31.6%, and 20.2% at 1, 2 and 3 years, respectively; those of nonsupported AVG were 31.9%, 17.4%, and 10.8%. The survival of nonsupported AVG was significantly inferior to that of externally supported AVG.
Externally supported AVG are superior to nonsupported AVG for long-term patency. The incompressibility and kinking resistance of ringed grafts may shed light on a direction for the future development of dialysis graft design.
Clinical Journal of the American Society of Nephrology 04/2010; 5(6):1029-35. · 5.23 Impact Factor
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ABSTRACT: Successful natural orifice transluminal endoscopic surgery (NOTES) procedures have been reported in animal studies. However, very little is known about the optimal approach for the application of these surgeries in the thoracic cavity. This study presents the feasibility of transtracheal evaluation of pleural cavity in a canine model using the NOTES technique.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2009; 37(5):1235-6. · 2.40 Impact Factor
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The Journal of thoracic and cardiovascular surgery 11/2009; 139(5):1349-50. · 3.41 Impact Factor
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ABSTRACT: To determine whether stent-to-vocal fold distance influences morbidity following stent placement for tracheal stenosis.
Fifty-five stent procedures (46 Montgomery T-tube [Boston Medical Products, Westborough, MA] and 9 Dumon stents [Novatech, Grasse, France]) were performed in 40 patients enrolled in this study.
The most common complication of stenting for tracheal stenosis was granulation (23 procedures, 41.82%). Of 43 procedures where the stent upper edge was located at or below the vocal folds, granulation occurred in 21 procedures (48.84%). Of 12 procedures where the stent edge was located above the vocal fold, granulation occurred in two procedures, or 16.67% (odds ratio = 4.773, P = .0458, chi(2) test). Among patients in whom the stent edge was located at or below the vocal folds, the granulation complication rate was higher in those with a stent-to-vocal fold distance of <10 mm. Multivariate analysis revealed that the stent-to-vocal fold distance independently predicted granulation formation; an inverse correlation was identified between stent-to-vocal fold distance and granulation severity (n = 43, r = -.501, P = .0006; Spearman ranking test). Receiver operating characteristic curve analysis further demonstrated that a stent-to-vocal fold distance cutoff value between 9.5 and 11 mm had the best accuracy in predicting granulation formation.
A stent-to-vocal fold distance of 10 mm was found to be a critical distance for discriminating granulation formation. Optimal stent-to-vocal fold distance should routinely be evaluated before stent placement.
The Laryngoscope 08/2009; 119(12):2331-6. · 1.75 Impact Factor
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ABSTRACT: Functional, long-lasting vascular access is essential for maintaining effective long-term haemodialysis. Previous studies have documented demographic factors and comorbid conditions associated with long-term vascular access. However, no studies have examined the effect of demography and timing of vascular access maturation on primary patency in Chinese incident haemodialysis patients.
We retrospectively enrolled 7028 adult incident patients who began haemodialysis between 1 January and 31 December 2002. A total of 5890 patients with mature arteriovenous fistula or arteriovenous graft, before or after beginning regular haemodialysis, were identified between 1 January 2000 and 31 December 2003. The Cox regression hazard model was used to assess the impact of sex, age, diabetes, type of access and timing of vascular access maturation on the duration of primary vascular access patency.
Of the study population, 2920 patients (50%) had diabetes; 4929 patients (84%) received fistulas and 961 (16%) grafts. Grafts, female sex and advanced age were significantly associated with shorter primary vascular access patency duration (P < 0.05). Diabetes was a risk factor for shorter primary vascular access patency duration for incident patients with mature fistulas before or after initiation, but not for patients with mature graft. Arteriovenous graft placement and maturation were better when completed >6 months prior to haemodialysis initiation for the duration of primary access patency.
Demographic characteristics and timing of vascular access maturation affect access type and duration of primary access patency among incident patients. Individual programmes for vascular access may be necessary to establish functional long-term access.
Nephrology Dialysis Transplantation 06/2009; 24(11):3447-53. · 3.40 Impact Factor
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ABSTRACT: The benefit of bullae ablation for the management of primary spontaneous pneumothorax (PSP) has been established. However, various modalities for bullae ablation have been reported from different centers.
The present study aimed to assess whether endoloop ligation of bullae was as effective as staple bullectomy for preventing the recurrence of pneumothorax.
Between January 1993 and December 2003, 226 patients (203 men and 23 women) with PSP were recorded and retrospectively reviewed. One hundred thirty (57.5%) patients were treated with endoloop ligation of bullae and the other 96 (42.5%) were treated with staple bullectomy. Mechanical abrasion was performed in all patients after bullae ablation.
The recurrence rate of pneumothorax was 6.2% (8 patients) in the endoloop ligation group and 17.7% (17 patients) in the staple bullectomy group (p = 0.006). The postoperative complication rate was 14.6 and 20.8% in the endoloop ligation and staple bullectomy groups, respectively (p = 0.221). The long-term chest discomfort rate after endoloop ligation and staple bullectomy was 14.6 and 13.5%, respectively (p = 0.819)
Endoloop ligation of bullae is as effective as mechanical staple bullectomy for the management of bullae in primary spontaneous pneumothorax.
World Journal of Surgery 03/2009; 33(5):938-42. · 2.36 Impact Factor
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ABSTRACT: Although autogenous arteriovenous fistulae are the optimal route for dialysis access, extended polytetrafluoroethylene (ePTFE) grafts continue to be the preferred access for patients without suitable superficial veins. Among the common complications related to dialysis grafts, thrombosis due to graft outlet stenosis is the most frequently encountered clinical problem. A cuffed graft was designed to eliminate the outflow turbulence to reduce outlet stenosis and to enhance the clinical patency of ePTFE grafts. We conducted a prospective, randomized study to compare the clinical outcomes of cuffed ePTFE grafts and noncuffed grafts in dialysis access.
Between November 2004 and October 2005, 89 ePTFE grafts were implanted for hemodialysis access in the upper extremities of end-stage renal patients. Graft selection was randomized, with patients receiving a cuffed graft (Venaflo) or a regular noncuffed graft (Stretch Gore-Tex). All patients were monitored for signs of thrombosis or other complications. Primary and secondary graft patency was analyzed by using a life-table analysis, and the log-rank test was applied to compare graft patencies.
Demographic data for both groups were similar without statistical difference. The primary patency rates and secondary patency rates at 12 months after implantation were 56% and 91% for cuffed grafts, and 41% and 78% for noncuffed grafts, respectively. The cuffed group outperforms the noncuffed group regarding primary and secondary patencies statistically. However, the incidence of other complications that required further surgery was similar in both groups.
This investigation revealed that the cuffed ePTFE graft, which was designed to decrease graft outlet stenosis, may enhance the clinical patency rates of dialysis grafts.
World Journal of Surgery 02/2009; 33(4):846-51. · 2.36 Impact Factor
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ABSTRACT: Major vessel (aorta or iliac vessels) injury is a rare yet catastrophic complication of spinal surgery. Prompt diagnosis is vital for effectively treating these injuries. A 56-year-old female with iliac artery iatrogenic injury during lumbar discectomy was successfully treated by percutaneous placement of a self-expanding stent graft in an emergent setting in an angiography suite. Postprocedural angiogram demonstrated complete exclusion of the pseudoaneurysm without contrast agent leakage. Endovascular treatment is suggested as an excellent alternative to open surgery for iatrogenic great vessel injuries, particularly in critical conditions.
Annals of Vascular Surgery 06/2008; 23(2):255.e7-11. · 1.03 Impact Factor
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ABSTRACT: Vascular surgeons often encounter dialysis graft failure in hemodialysis patients during their daily practice. Despite advances in percutaneous treatment, there remains a role for surgical thrombectomy of thrombosed dialysis grafts. This study was designed to investigate the long-term outcome of dialysis graft thrombectomy and to examine the indications for and effectiveness of therapies adjuvant to Fogarty thrombectomy.
Surgical outcomes of 590 consecutive dialysis graft thrombectomies performed between 2001 and 2003 were retrospectively reviewed. The 590 cases were classified into four groups based on the procedure performed adjuvant to Fogarty thrombectomy: group A, surgical thrombectomy by Fogarty thrombectomy catheter alone; group B, thrombectomy plus intraoperative angioplasty of graft outlet; group C, thrombectomy plus sequential balloon angioplasty in subsequent intervention; group D, thrombectomy plus graft outlet surgical revision. Age, gender, co-morbidity, and primary patency of grafts were reviewed and analyzed.
The four groups exhibited similar demographic features and comorbidities (p>0.05). Mean primary patency in the four groups was 1.99+/-4.02, 7.21+/-7.61, 8.35+/-9.53, and 7.26+/-6.99 (months), respectively. Survival curves for each group were determined by Kaplan-Meier methods. Primary patency in group A was statistically inferior to all of the other three groups, whereas groups B, C, and D did not significantly differ with regard to graft patency.
Surgical thrombectomy alone is inadequate for treating a thrombosed dialysis graft. The underlying graft outlet stricture requires direct surgical revision or balloon angioplasty during surgery or intervention in the angiography suite to ensure long-term patency of the graft.
World Journal of Surgery 03/2008; 32(2):241-5. · 2.36 Impact Factor
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ABSTRACT: Surgical resection (SR) is the most effective strategy in the management of patient with lung abscess who have failed medical treatment. Surgical drainage (SD) of lung abscess is an alternative in high-risk patients. There are limited findings in comparing the two procedures. The aim of this study was to compare surgical outcomes in patients who underwent SR versus SD.
We retrospectively reviewed 61 patients receiving surgical intervention for lung abscess in our hospital from 1994 to 2002. The patients were divided into two groups according to different surgical procedure. They are patients who received SR (lobectomy, pneumonectomy or wedge resection) and patients who underwent SD (pneumonotomy) of lung abscess.
There were 33 patients enrolled in SD and 28 patients in the SR for lung abscess. There was no significant difference between the two groups in number of risk factors or size or location of abscess. The operation time and blood loss seemed to be less in SD, although they did not reach statistic difference. Postoperative major complications were more frequent for SD than for SR (36.3 vs 32.1%, P = 0.038). The mortality rate and total complication rate were similar.
When surgery is indicated for lung abscess, SR is the preferred procedure. Whenever there are great difficulties during SR or patients are unable to tolerate major pulmonary resection, SD can be an alternative choice. The techniques were relatively easy and effective. The surgical outcomes in short term was favourable and can be comparable to that of standard SR.
ANZ Journal of Surgery 11/2007; 77(10):852-4. · 1.25 Impact Factor
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ABSTRACT: Stenting is an effective method of treating airway stenosis. However, airway obstruction due to mucus plugging is problematic. Treatment of this has mainly been conservative. This report describes a patient with complicated tracheal stenosis treated with silicone hood stent, who experienced repeated episodes of airway obstruction due to sputum accumulation. A novel method of sputum clearance and self-care, using a long endotracheal tube within the silicone stent, is described. This procedure resulted in a stable and patent airway, and the patient was discharged smoothly after the procedure. No further respiratory symptom occurred during the follow-up period.
Respirology 10/2007; 12(5):780-2. · 2.42 Impact Factor
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Saudi medical journal 07/2007; 28(6):973-5. · 0.52 Impact Factor
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ABSTRACT: Objectives. To evaluate the necessity and effectiveness of different adjunctive therapies used with dialysis graft surgical thrombectomy. Method. We reviewed the records of 590 consecutive surgical dialysis graft thrombectomies performed in a medical center between Aug. 2001 and Aug. 2003. All cases underwent Fogarty thrombecotmies and were classified into four groups: ONLY group, those receiving surgical thrombectomies using Fogarty thrombectomy catheter alone (300 cases); ANGIO group, those receiving thrombectomies plus intraoperative angioplasties of graft outlets (110 cases); REVS group, those receiving thrombectomies plus graft outlet surgical revisions (126 cases) and SEQL group, those receiving thrombectomies plus sequential balloon angioplasties, over separate sessions (54 cases). Age, gender, graft age, co-morbidity and primary patency of the graft were also reviewed. Cost of each group was determined by the average time, professional labor, and materials used complete all the procedures. Results. Patients in all four groups had similar demographic characteristics and comorbidities (p>0.05). The mean primary patency of four groups are 1.99±4.02, 7.21±7.61, 8.35±9.53, 7.26±6.99 (months), respectively. The effectiveness (primary patency period ) of ONLY group was statistically inferior to that of the other three groups. Although the methods used to treat graft outlet stenosis in ANGIO, REVS, and SEQL groups were found to be equally effective, REVS group was found to be the most cost effective (2.76-2.94 USD/per patency day, with different salary level), the second cost effective was ONLY group (2.81-3.14 USD/per patency day), the third was group ANGIO group (3.13-3.27 USD/per patency daty) and SEQL group is the most expensive (3.16-3.37 USD/per patency day). Conclusion. Although cost-effectiveness of thrombectomy alone (ONLY group) was found to be similar to that of REVS group and cheaper than the modalities used for ANGIO and SEQL groups, it results in much more inferior outcomes. Based on our findings, thrombectomy plus graft outlet surgical revision had the best primary patency and was most cost-effective. However, from patients' aspect, it will be more convenient and less painstaking to be treated for all the medical problems surrounding graft outlet stenosis at one time. Considering the invasiveness, procedure time and the effectiveness of the procedures, intraoperative angioplasty of graft outlet is the most reasonable adjunct treatment of graft outlet stenosis associated with trombectomies.
HEN: Other Specific Diseases or Therapies (Sub-Topic). 06/2007;
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Asian cardiovascular & thoracic annals 05/2007; 15(2):178-9.
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ABSTRACT: Catamenial hemoptysis is a rare disease. Hormone ablation therapy is the treatment of choice with multiple side effects. We report a case of pulmonary endometriosis with deep and changeable focus. Successful treatment was obtained with the combine use of computed tomography-guided hook-wire localization and video-assisted thoracoscopic surgery. Owing to benign and curable in nature, we suggest a more aggressive attitude toward this disease before proceeding to hormone ablation therapy. The role of preoperative localization in the management of such disease was also discussed.
Surgical laparoscopy, endoscopy & percutaneous techniques 01/2007; 16(6):437-8. · 1.23 Impact Factor
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ABSTRACT: The objective of this study was to determine prospectively the difference between the graft outlet strictures of a polytetrafluoroethylene (ePTFE) graft with a cuff at the graft-vein anastomosis (Venaflo; Bard industries, Tempe, Ariz.) and that of the regular ePTFE graft (Stretch Gore-Tex; Gore, Flagstaff, Ariz.) placed for hemodialysis access.
Between January and April 2005, 36 consecutive patients (average age: 63.3 years) underwent ePTFE graft implantation (36 implantations) for hemodialysis at the Vascular Surgery Section of Chang Gung Memorial Hospital. The patients of the study cohort were randomly assigned to two groups based on the graft used: cuffed graft group (Venaflo graft) and non-cuffed standard graft group (Gore-Tex graft). Each patient underwent antegrade venography at the 3-month follow-up to demonstrate the graft outlet stricture. Results of the graft outlet angiography analysis were examined, and all medical records were reviewed at end of the study. The degree of the graft outlet stenosis was compared between the two groups.
Average stenosis of the cuffed graft group and non-cuffed (standard) graft group were 22.76 +/- 26.37%% and 44.95 +/- 27.48%%, respectively; the difference between the two groups was statistically significant (P < 0.05).
The graft outlet stricture of cuffed ePTFE grafts for hemodialysis 3 months after implantation was less severe than that for the standard ePTFE graft. The correlation between the stricture level and dialysis graft patency requires further clarification.
World Journal of Surgery 01/2007; 30(12):2290-4. · 2.36 Impact Factor
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ABSTRACT: The Montgomery T-tube (T-tube) is an effective device for relieving tracheal stenosis when lesions are inappropriate for surgical reconstruction. Several techniques have been developed for the insertion of the T-tube in difficult conditions. The aim of this study was to present our experience using a rigid bronchoscope for T-tube insertion. A retrospective chart review of patients with tracheal stenosis who underwent T-tube insertion between April 2002 and July 2005 was conducted. Thirty-seven patients underwent 53 T-tube placements. Successful stent placement was achieved in all 37 patients. The T-tube was not tolerated in six patients because of granulation obstruction of the upper limb or sputum impaction. Thirty-one patients had good long-term results and enjoy adequate airway with the T-tube. There was no procedure-related mortality and there were no complications. Rigid bronchoscopic insertion of the T-tube for tracheal stenosis is a safe and an effective procedure. It ensures the correct placement of the T-tube when the technique described by Montgomery fails.
ANZ Journal of Surgery 10/2006; 76(9):853-4. · 1.25 Impact Factor
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ABSTRACT: Stent placement may induce granulation tissue, occlude the stent lumen, and exacerbate respiratory symptoms. Microdebrider was designed to treat laryngeal papillomas and airway stenosis. However, little research exists on the management of airway stenosis following airway stenting with microdebrider. This study describes two cases of glottic stenosis caused by airway stenting successfully treated with mibrodebrider.
European Journal of Cardio-Thoracic Surgery 09/2006; 30(2):388-90. · 2.55 Impact Factor
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Pediatric Radiology 03/2006; 36(2):168. · 1.67 Impact Factor
