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World Journal of Gastroenterology 2016年第11期22卷 3127-3149页

作者： Alan Alper Sag Fatih Selcukbiricik Nil Molinas Mandel Division of interventional Radiology Department of RadiologyKoc University School of Medicine Division of Medical Oncology Department of Internal MedicineKoc University School of Medicine

Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is(limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.

关键词： Colonic neoplasms Rectal neoplasms Neoplasm metastasis Antineoplastic agents FOLFOX protocol Irinotecan 5-flurouracil and leucovorin protocol Radiofrequency ablation Microwave ablation Chemoembolization Therapeutic Immunotherapy

Liver-directed therapies for liver metastases from neuroendocrine neoplasms:Can laser ablation play any role?

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World Journal of Gastroenterology 2020年第23期26卷 3118-3125页

作者： Sergio Sartori Lara Bianchi Francesca Di Vece Paola Tombesi department of internal medicine Section of Interventional UltrasoundSt.Anna HospitalFerrara 44100Italy

Aggressive cytoreduction can prolong survival in patients with unresectable liver metastases(LM)from neuroendocrine neoplasms(NEN),and minimally invasive,liver-directed therapies are gaining increasing ***-based treatments are used in disseminated disease,whereas ablation techniques are usually indicated when the number of LM is *** radiofrequency ablation(RFA)is by far the most used ablative technique,the goal of this opinion review is to explore the potential role of laser ablation(LA)in the treatment of LM from *** uses thinner needles than RFA,and this is an advantage when the tumors are in at-risk ***,the multi-fiber technique enables the use of one to four laser fibers at once,and each fiber provides an almost spherical thermal lesion of 12-15 mm in *** a characteristic enables to tailor the size of each thermal lesion to the size of each tumor,sparing the liver parenchyma more than any other liver-directed therapy,and allowing for repeated treatments with low risk of liver failure.A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA,that can play a useful role in the multimodality approach to LM from NEN.

关键词： Neuroendocrine neoplasms Liver metastases Liver-directed therapies Ablation techniques Laser ablation Radiofrequency ablation

interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

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World Journal of Gastroenterology 2009年第40期15卷 5028-5034页

作者： Feng-Yong Liu Mao-Qiang Wang Qing-Sheng Fan Feng Duan Zhi-Jun Wang Peng Song department of interventional Radiology Clinical Division of Internal Medicine Chinese People's Liberation Army General Hospital Beijing 100853 China

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

关键词： Portal thrombosis Superior mesenteric vein thrombosis Thrombolysis interventional treatment

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum:A case series

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World Journal of Gastroenterology 2017年第17期23卷 3084-3091页

作者： Johanna Wilmsen Robert Baumbach Dietmar Stüker vincens Weingart Frank Neser Stefan Karl Golder Christof Pfundstein Ellen Claudia Notzel Thomas Rosch Siegbert Faiss department of Gastroenterology and interventional Endoscopy Asklepios Hospital BarmbekSemmelweis UniversityMedical Faculty department of Interdisciplinary Endoscopy University Medical Center Tübingen department of internal medicine Garmisch-Partenkirchen Medical Center department of internal medicine II Hospital Chemnitz department of internal medicine III Private Practice for internal medicine and Gastroenterology department of internal medicine and Gastroenterology Sana Hospital Lichtenberg department of Interdisciplinary Endoscopy University Medical Center Hamburg-Eppendorf

AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible *** November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic *** eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not *** endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.

关键词： Zenker’s diverticulum Flexible endoscopic treatment Stapler technique Overtube Surgical stapler

Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access

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World Journal of Clinical Cases 2015年第9期3卷 835-837页

作者： Adeel M Siddiqui Gregory S Harris Assad Movahed Karl S Chiang Mihail G Chelu Rajasekhar Nekkanti department of internal medicine East Carolina School of Medicine department of Cardiovascular Sciences East Carolina Brody School of Medicine Vascular interventional Radiology Vidant Medical Center

The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with endstage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker.

关键词： Trans-hepatic venous access Permanent cardiac pacemaker End-stage renal disease

Prognostic utility of NT-proBNP greater than 70,000 pg/mL in patients with end stage renal disease

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Journal of Geriatric Cardiology 2018年第7期15卷 476-478页

作者： Julio Perez-Downes Carlos Palacio Saif Ibrahim Patrisha Shelley Alan Miller Pramod Reddy Division of General internal medicine University of Florida College of Medicine-Jacksonville USA department of interventional Cardiology University of Alabama Birmingham Birmingham AL USA Division of Cardiology Department ofMedicine University of Florida College of Medicine- Jacksonville USA

Natriuretic peptides are synthesized in ventricular myocytes and released into the circulation in response to increased myocardial wall stress, Causes of myocardial wall stress include pulmonary hypertension, ventricu... 详细信息

关键词： End stage renal disease Heart failure Heart failure reduced ejection fraction Mortality NT-proBNP

Capsule endoscopy:Present status and future expectation

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World Journal of Gastroenterology 2014年第29期20卷 10024-10037页

作者： Mahesh K Goenka Shounak Majumder Usha Goenka Institute of Gastro Sciences Apollo Gleneagles Hospitals department of internal medicine University of ConnecticutFarmingtonCT 06269United States department of Imaging and interventional Radiology Apollo Gleneagles Hospitals

video capsule endoscopy (CE) since its introduction 13 years back, has revolutionized our approach to small intestinal diseases. Obscure gastrointestinal bleed (OGIB) continues to be the most important indication for CE with a high sensitivity, specificity as well as positive and negative predictive values. It is best performed during ongoing bleed or immediately thereafter. Overt OGIB has a higher diagnostic yield than occult OGIB. However, even in iron deficiency anemia, CE is emerging as important investigation after initial negative work up. In suspected Crohn’s disease (CD), CE has been shown superior to traditional imaging and endoscopic technique and should be considered after a negative ileocolonoscopy. Although CE has also been used for evaluating established CD, a high capsule retention rate precludes its use ahead of cross-sectional imaging. Celiac disease, particularly where gastro-duodenoscopy cannot be performed or is normal, can also be investigated by CE. Small bowel tumor, hereditary polyposis syndrome, and non-steroidal anti-inflammatory drugs induced intestinal damage are other indications for CE. Capsule retention is the only significant adverse outcome of CE and occurs mostly in presence of intestinal obstruction. This can be prevented by use of Patency capsule prior to CE examination. Presence of cardiac pacemaker and intracardiac devices continue to be relative contraindications for CE, though data do not suggest interference of CE with these devices. Major limitations of CE today include failure to control its movement from outside, inability of CE to acquire tissue for diagnosis, and lack of therapeutic help. With ongoing interesting and exciting developments taking place in these areas, these issues would be solved in all probability in near future. CE has the potential to become one of the most important tools in diagnostic and possibly in the therapeutic field of gastrointestinal disorder.

关键词： video capsule Small bowel Obscure gastrointestinal bleeding Celiac disease Crohn's disease Small bowel tumor

Disabling portosystemic encephalopathy in a non-cirrhotic patient: successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein

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World Journal of Gastroenterology 2017年第47期23卷 8426-8431页

作者： Luca de Martinis Gloria Groppelli Riccardo Corti Lorenzo Paolo Moramarco Pietro Quaretti Pasquale De Cata Mario Rotondi Luca Chiovato Unit of Endocrinology and internal medicine University of PaviaICS Maugeri SPA SocietàBenefit Unit of interventional Radiology Radiology DepartmentIRCCS Fondazione Policlinico San Matteo

Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/d L(reference range viral markers were negative. The patient was started on lactulose, rifaximin and low-protein *** the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.

关键词： Non-cirrhotic patient Portosystemic shunt Hyperammonaemia interventional radiology Mechanical embolization Encephalopathy

Acute lymphocytic myocarditis

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Journal of Geriatric Cardiology 2018年第7期15卷 527-528页

作者： Maedeh Ganji Jose Ruiz-Morales Saif Ibrahim Cardiology department University of Florida Jacksonville FL USA internal medicine department University of Florida Jacksonville FL USA interventional Cardiology department University of Alabama-Birmingham Birmingham AL USA

Myocarditis is an inflammatory disease of the myocardium. The clinical presentation of myocarditis may range from subclinical to sudden death. The incidence of fatal myocarditis, which often presents with sudden or rapid death, has been estimated at 0.15/100.000 in the general population and is highest in infants and young adults （but may affect any age group）. However, diffuse myocarditis in autopsies of sudden death is 〈 2% in adult.

关键词： Cardiomyopathy Myoearditis Heart attack STEMI Sudden cardiac death

In-hospital outcomes and readmission in older adults treated with percutaneous coronary intervention for stable ischemic heart disease

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Journal of Geriatric Cardiology 2022年第9期19卷 631-642页

作者： Dae Yong Park Jonathan M.Hanna Sumeet Kadian Mannat Kadian WSchuyler Jones Abdulla Al Damluji Ajar Kochar Jeptha P.Curtis Michael G.Nanna department of medicine Cook County HealthChicagoILUSA department of internal medicine Yale School of MedicineNew HavenCTUSA University of Connecticut StorrsCTUSA East Lyme High School East LymeCTUSA Section of interventional Cardiology Duke University Health SystemDurhamNCUSA Section of interventional Cardiology Johns Hopkins UniversityBaltimoreMDUSA Section of interventional Cardiology Brigham and Women’s HospitalBostonMAUSA Section of Cardiovascular medicine Yale School of MedicineNew HavenCTUSA

Background Percutaneous coronary intervention(PCI)for stable ischemic heart disease(SIHD)in older adults requires a metic-ulous assessment of procedural risks and benefits,but contemporary data on outcomes in this population is ***,we examined the risk of near-term readmission,bleeding,and mortality in high-risk cohort of older adults undergoing inpatient PCI for *** We analyzed the National Readmissions Database from 2017 to 2018 to identify index hospitalizations in which PCI was performed for *** were stratified into those≥75 years old(older adults)and those<75 years *** primary outcome was 90-day *** outcomes included in-hospital mortality,hospital length of stay(LOS),and total hospital *** A total of 74,516 patients underwent inpatient PCI for SIHD,of whom 24,075 were older *** adult patients had higher odds of in-hospital mortality(OR=2.00,95%CI:1.68-2.38),intracranial hemorrhage(OR=2.03,95%CI:1.24-3.34),and gastrointestinal hemorrhage(OR=1.72,95%CI:1.43-2.07)during index hospitalization,with longer LOS and in-hospital *** adults also experienced a higher hazard of 90-day readmission for any cause(HR=1.61,95%CI:1.57-1.66)and car-diovascular causes(HR=1.84,95%CI:1.77-1.91).CONCLUSION Older adults undergoing inpatient PCI for SIHD were at increased risk for in-hospital mortality,periprocedural morbidities,higher cost,and readmissions compared with younger *** these differences may improve shared decision-making for patients with SIHD being considered for PCI.

关键词： mortality coronary younger