Alligator Forceps Research Articles

This Is the Pits: A Case of Esophageal Foreign Body Impaction

Purpose: The esophagus is the most common location in the gastrointestinal (GI) tract for foreign body impactions and endoscopic removal is the best treatment. While performing endoscopic foreign body removal, it is critical to protect the airway from inadvertent aspiration of saliva and the object during extraction. Indications for tracheal intubation prior to endoscopy include inability to tolerate secretions or finding a radiopaque object within the esophagus. We present the case of a patient able to tolerate secretions after swallowing an apricot pit, whose radiographic film was initially read negative, who during endoscopy was found to have the pit impacted just distal to his upper esophageal sphincter (UES). Methods: A 79-year-old Hispanic male presents five hours after ingesting an apricot pit. The patient initially coughed up pieces of apricot but was unsure if the pit had been expelled. Initially he felt pain and neck fullness but subsequently only experienced odynophagia. On exam, he was afebrile, with normal blood pressure and pulse, chest without crepitus, and soft, nontender abdomen. Labs were unremarkable. A neck soft tissue series was initially read negative. Upon endoscopic esophageal intubation the apricot pit was seen just distal to the UES. The endoscope was withdrawn and the patient intubated for airway protection. The endoscope was reinserted and attempts at removal including use of Roth net, snare, stone extraction basket, alligator forceps, three prong polyp grabber, and ERCP stone extraction balloon were unsuccessful. Airway protection and access were aided by esophageal overtube. After prolonged attempts endoscopy was aborted. Otorhinolaryngology was consulted who decided to remove the pit with a rigid esophagoscope in the Operating Room. The pit was successfully removed under general anesthesia and inflamed, edematous tissue was noted. Review of the initial soft tissue film confirmed the radiopaque pit in the esophagus. Gastrograffin study after removal did not demonstrate a perforation. Subsequent upper GI barium esophagram was without obstruction. The patient was discharged without complication two days later. Conclusion: The presence of persistent high esophageal obstruction should be suspected even in the absence of alarm symptoms and despite normal imaging. Our patient is unusual in terms of his benign complaints and normal studies. Endoscopic attempts at removal of high esophageal foreign body impactions are reasonable to attempt as long as adequate airway protection is in place.

A Feasible Approach for Extraction of Dental Prostheses From the Airway by Flexible Bronchoscopy in Concert With Wire Loop Snares

Tracheobronchial foreign body (FB) aspiration is a common problem worldwide, and the aspired objects can be very difficult to remove. Bronchoscopic removal of airway FBs can be safely accomplished with both rigid as well as flexible bronchoscopes. It is well known that a rigid bronchoscope more easily removes large FBs located in the central bronchi. A wide variety of instruments, such as biopsy forceps, Fogarty balloon catheters, alligator forceps, or wire baskets, are commonly available for removal. Herein, we report the case of a 75-year-old man with an airway dental prosthesis, the shape and composition of which complicated its extraction from the nearly totally occluded left main bronchus, using biopsy forceps and wire baskets. We describe the successful extraction of the challenging FB with a flexible bronchoscope in concert with wire loop snares and the avoidance of rigid bronchoscopy or thoracotomy.

Electrocoagulation of an Endobronchial Adhesion

TO THE EDITOR: Therapeutic endoscopy is underused in developing countries. We describe a case report in Vietnam, in which an adhesion of the left main bronchus was lysed and vaporized using electrocoagulation in conjunction with a flexible bronchoscope. The availability of electrocoagulation equipment and physicians trained in its use would be a major advance in these countries due to its effectiveness, its relatively low cost, the multidisciplinary utility of its electric generator, the rapid learning curve for the endoscopist, and the simplicity of equipment maintenance. High-frequency thermocoagulation is used increasingly to treat benign and malignant tracheobronchial lesions in the industrially advanced countries.1–3 As this technique is easy to use, relatively inexpensive, and very effective,4 it should be introduced in developing countries as well. Tracheal stenosis after prolonged endotracheal intubation or after tracheostomy is a recognized complication.5 Bronchial stenotic lesions are less frequent and in developing countries are often secondary to tuberculosis, when they occur. Although treatment with Nd-YAG laser has been popularized in these situations, substitution of electrocoagulation is an important alternative to consider.6,7 We describe a case of a Vietnamese woman who presented with a bronchial adhesion, which was removed by electrocautery to prepare her for surgical excision of her lower lobe. A 45-year-old woman was initially hospitalized during August 2005, for productive cough, left thoracic pains, and hemoptysis. She had been treated 20 years earlier for pulmonary tuberculosis. Plain films of the chest now indicated left lower lobe atelectasis. Flexible bronchoscopy revealed an antero-posterior adhesion, midway along the left main bronchus. Just behind the adhesion was a foreign body associated with significant suppuration. The foreign body was removed with an alligator forceps; it was very hard and could not be identified nor could the patient recall any episodes of foreign body aspiration. She was treated with antibiotics, corticosteroids, respiratory therapy, and discharged from the hospital. In October 2005, moderate hemoptysis recurred. Endoscopic examination was unchanged except for the presence of purulent secretions emanating from the left lower lobe. Plain films and computerized tomography of the chest demonstrate basilar atelectasis and bronchiectasis of the left lower lobe (Fig. 1). Virtual bronchoscopy confirmed the presence of these abnormalities and the left main bronchial adhesion. It was decided to perform a left lower lobectomy to prevent further complications from the bronchiectasis, but the anesthesiologist insisted on eliminating the adhesion before surgery, to maximize ventilatory efficiency. The adhesion was easily sectioned using a flexible thermocoagulation sound (ERBE Tubingen, Germany) passed through a flexible bronchoscope, under local anesthesia, using the mild coagulation mode at 50 W (Figs. 1A–C). The lobectomy was performed the following day with no significant postoperative sequellae.FIGURE 1.: A, Electrocoagulation of the left lower lobe adhesion. B, Blanching due to coagulation. C, Destroyed adhesion.This case illustrates the ease and effectiveness of electrocoagulation. Except in critical situations, most benign and malignant lesions may be treated in ambulatory patients, under local anesthesia using a flexible fiberscope. Electrocoagulation should be the technique of first choice in developing countries which are just beginning to institute therapeutic endoscopy because of its relatively low cost, the multidisciplinary utility of its electric generator, the rapid learning curve for the endoscopist, and the simplicity of equipment maintenance. For our patient, the origins of the adhesion and the bronchiectasis remain speculative. The presence of the foreign body and her past tuberculosis infection are likely etiologies of her pathology. Most often, tuberculosis entrains concentric bronchial stenosis. We have also seen synechial subgottic adhesions secondary to prior intubation or tracheostomy. The stringlike adhesion seen here is unusual. Presumably, the adhesion prevented expulsion of the foreign body. Aspiration of foreign bodies is rather frequent among infants and less so in adults, where it depends on the eating and drinking habits of the individual.8–10 In South Vietnam, the sapotilla pit is the most frequent bronchial foreign body encountered.11 In our case, we were unable to ascertain the source of the foreign body from either its shape or its consistency. In summary, electrocoagulation should be the technique of choice in treating tracheobronchial lesions in the developing world, although, for instance, only 3 Vietnamese hospitals have access to thermocoagulation equipment. In Vietnam, tracheobronchial stenoses due to tuberculosis are frequently encountered, as are tracheal complications after intubation. In addition, bronchogenic carcinoma is often seen at a stage where local cautery treatments may significantly palliate the patient's symptoms due to bronchial obstruction. It is time to introduce these techniques in developing countries and to ensure that physicians are properly trained in their use. Jean P. Homasson, MD, FCCP H. Bakdach, MD F. Bartobin-Larrieu, MD Y. Aelony, MD, FACP, FCCP Association Franco-Vietnamienne de Pneumologie (AFVP), 24 rue Albert Thuret, 94669 Chevilly Larue, France Thach N. Tran, MD Hôpital Pham NGOC Thach and AFVP 120 Hung Vuong Str. Q 5, Ho Chi Minh Ville City, Vietnam

Mysterious Mediastinal Object

Mysterious Mediastinal Object

The Triune, a New Silicone Tympanostomy Tube

• 1589 Triune tubes were inserted in a two year period and followed every six months to determine the rate of extrusion and the complication rate. • 73% of patients followed up and the average extrusion was at 30 months. • Perforation rate was 2.2%, tube granulomas formed in 2.8%, and 6.2% of tubes became plugged. • 32% of the tubes developed otorrhea. • The conclusion is that the Triune is a medium term tube with a low complication rate. • Graphing the extrusion of 1158 tubes seen in follow up, it is evident that the average extrusion is at approximately 30 months, see below. • 26 of 1158 intubated ears seen in follow up developed perforations, which represents 2.2%. • 32 of 1158 tubes or 2.8% developed granulomas averaging 1.4 mm in size. All resolved with topical antibiotic/steroid drops. • Serous or blood clot plugs developed in 72 tubes or 6.2%. • Otorrhea occurred in 264 ears out of 818 questioned regarding drainage. This represents 32.3%. Results 1. Kay DJ, Nelson M, Rosenfield R. Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg 2001;124:374-80. 2. Goode RL. Long-term middle ear ventilation with T tubes: the perforation problem (editorial). Otolaryngol Head Neck Surg 1996;115:500-1. 3. Mandel EM, Casselbrant ML, Kurs-Lasky M. Acute otorrhea: bacteriology of a common complication of tympanostomy tubes. Ann Otol Rhinol Laryngol 1994; 103:713-718. Bibliography • Triune tubes were inserted into all the author’s patients needing more than brief middle ear ventilation in a private otolaryngology group practice. • Over a two year period from March, 2004 to March of 2006, 1,589 tubes were inserted, 1132 under general anesthesia and 458 under local anesthesia. • Patients were instructed to return in one month and every six months thereafter for microscopic examination. 1158 tubes or 73% were seen in follow up. • Complications were documented in a spreadsheet at every return visit with a mean follow up of 12.3 months. • Tubes were manufactured using a cold extrusion process by Grace Medical in Memphis, Tenn. • Tubes were inserted using micro alligator forceps with the lower jaw in the lumen of the tube. See figure 2 below. Methods and Materials Figure 3-Extrusion Rate • The Triune tube ventilates the middle ear an average of 30 months. • The Triune Tube has a low perforation rate, particularly considering the 30 months to extrusion. • Most likely the low perforation rate is related to the tube’s conformity to the convex shape of the TM. Conclusions The premise of the Triune’s design is that the T-tube causes a high percentage of perforations due to the “tenting” of the tympanic membrane by the perpendicular arms. The Triune tube was intended to conform closely to the convex shape of the tympanic membrane and to stabilize the tube perpendicular to the plane of the TM by using three soft arms that are angled down 15 degrees from perpendicular. The arms are .2mm in thickness, soft, flat, and therefore relatively atraumatic to the TM. See figures below. n=823 n=666 n=373 n=503 n=321 n=201 n=203 0 5 10 15 20 25 30 35 40 45 50 4 8 12 16 20 24 28 P e rc e n ta g e E x tr u d e d Months Post Insertion Extrusion Rate

Foreign body in the airway: unusual cause of acute dyspnoe after cardiac surgery

We report on a 68-year-old male who presented with acute onset of dyspnoea and cough. After coronary artery bypass grafting and mitral valve repair with an annuloplasty ring, postoperative recovery was initially uneventful. On the 6th postoperative day, he came back to intensive care unit due to acute dyspnoea. Fig. 1 demonstrates chest x-ray. We identified the foreign body as a dental prosthesis (Fig. 2). Removal from the right bronchial tree was successful using a flexible bronchoscope under local anesthesia; intubation was not required. This procedure was safe and well tolerated by the patient. Clinical presentation of adult foreign body aspiration are often nonspecific. Chest x-ray is very helpful for identification and localization of foreign bodies in the airway. Extraction can be performed with flexible or rigid bronchoscopy. For the removal, biopsy forceps, Fogarty balloon catheter, alligator forceps or wire baskets are effective.

Endoscopic Removal of Metallic Airway Stents

Complications of metallic airway stents include granulation tissue formation, fracture of struts, migration, and mucous plugging. When these complications result in airway injury or obstruction, it may become necessary to remove the stent. There have been few reports detailing techniques and complications associated with endoscopic removal of metallic airway stents. We report our experience with endoscopic removal of 30 such stents over a 3-year period. We conducted a retrospective review of 25 patients who underwent endoscopic stent removal from March 2001 to April 2004. The patients ranged in age from 17 to 80 years (mean, 56.3 years). There were 10 male and 15 female patients. The stents had been placed for nonmalignant disease in 20 patients (80%) and malignant disease in 5 patients (20%). All procedures were done under general anesthesia with a rigid bronchoscope. Special attention was focused on the technique of stent removal and postoperative complications. Thirty metallic airway stents were successfully removed from 25 consecutive patients over a 3-year period. The basic method of removal involved the steady application of traction to the stent with alligator forceps. In all cases, an instrument such as the barrel of the rigid bronchoscope or a Jackson dilator was employed to help separate the stent from the airway wall before removal was attempted. In some instances, the airway wall was pretreated with thermal energy prior to stent removal. Complications were as follows: retained stent pieces (n = 7), mucosal tear with bleeding (n = 4), re-obstruction requiring temporary silicone stent placement (n = 14), need for postoperative mechanical ventilation (n = 6), and tension pneumothorax (n = 1). Although metallic stents may be safely removed endoscopically, complications are common and must be anticipated. Other investigators have described airway obstruction and death as a result of attempted stent removal. Placement and removal of metallic airway stents should only be performed at centers that are prepared to deal with the potentially life-threatening complications.

A nose for trouble

Nasal FBs, for example, are almost exclusively seen among children and people with learning difficulties, and are fairly rare outside these groups. Kalan and Tariq (2000) observe that, while nasal FBs may be suspected, proving their presence can be challenging. During the festive period of December, a 23-year-old woman presented to the emergency department (ED) at the Bristol Royal Infirmary one evening complaining of bilateral nasal FBs. She described them as magnetic novelty earrings that she had tried to use as nasal jewellery. Physical examination was unremarkable, and inspection of the nasal cavities with speculum and otoscope provided no evidence of nasal airway obstruction. Yet the patient was adamant that the magnetic parts of the earrings were stuck in her nose. The ENP who treated the patient requested occipitomental facial and lateral nasal X-ray views to demonstrate the presence or otherwise of radio-opaque FBs. The radiographs confirmed the presence of two FBs on either side of the nasal septum, the magnets being attracted to each other across it. The lateral view indicated that the FBs were on the nasal floor. Repeat examination was clearly required, although extreme caution was taken to prevent pushing the FBs into the postnasal space with the associated risk of accidental aspiration. On this occasion, both FBs could be seen on the nasal floor, but the magnetic attraction was too strong for easy removal. An attempt was made with alligator forceps, and the FB from the left nostril was recovered; unfortunately, the patient at this point sneezed and swallowed the now freed magnet from the right. No signs of respiratory distress were encountered and auscultation of lung fields was clear with no added sounds. The patient was also certain she had ingested the remaining FB. Due to the magnet’s smooth nature and small size – it was 8mm in diameter and 1mm wide – it was decided to leave it to pass naturally. Re-inspection of the nasal cavities revealed no evidence of septal

The duration of use, causes of discontinuation, and problems during removal in women admitted for removal of IUD

Objective Our aim was to determine the duration of intrauterine device (IUD) use, reasons for discontinuation, and problems encountered during removal in patients who were admitted to our clinic for removal of IUD. Materials and Methods We studied 321 cases of IUD removal with respect to duration of use, cause of removal, type of IUD used, and sociodemographic characteristics. The relationships among duration of use, patient's level of education, medical facility where the IUD was inserted, and number of children were analyzed. The reasons for removal and their relationship to duration of use were investigated. We also investigated the problems encountered during removal. Findings The mean age of cases included in the study was 34.8±1 years, mean number of children was 2.3±1.5, and mean duration of use was 5.8±3.9 years. The type of IUD most frequently removed was TCu-380A (86.3%). Although there was no correlation between the duration of use and the type of medical facility where the IUD was inserted, we observed that women with more children used IUDs for longer periods. When cases were evaluated for level of education, there was a statistically significant difference between university graduates and illiterate/primary school graduate women (p=.032 and .029, respectively). The reasons for removal were frequently side effects related to IUD use, expired date of use, and desire for conception. Pregnancy during IUD use was observed in 16 cases (5%). Removal of IUD was achieved without problems in 263 cases (81.9%), whereas alligator forceps needed to be used in 44 cases (13.7%). Conclusion IUD is the most frequently used contraceptive method in our country. We have observed a long duration of use in the women studied, with minimal problems during removal.

Aural Myiasis in Children and Literature Review

Myiasis is a disease caused by fly larvae. The term "myiasis" is derived from the Greek word "myia" meaning fly. Aural myiasis is a rare clinical state and occurs frequently in children. In this article, six children with aural myiasis, caused by the fly larvae, are reported because of unusual presentation. All of the children with aural myiasis were associated with chronic otitis media. In the treatment, a combination of suctioning and alligator forceps was used to remove maggots under the light microscopic field. Additionally, antibiotics were used in all children. Thus, aural myiasis is successfully treated by direct extraction of larvae and application of preventative methods.

Aural irrigation using the OtoClear ® Safe Irrigation System in children

To evaluate the safety and efficacy of the OtoClear Safe Irrigation System for removing cerumen from the external auditory canal in children. Eligible subjects were 6 months-17 years of age with cerumen obstructing > or = 50% of the tympanic membrane (TM) from view (by otoscopy). Pneumatic otoscopy, tympanometry, and audiometry were performed followed by cleansing of the affected ear canal(s) with the OtoClear Safe Irrigation System and warm tap water. Otoscopy was performed after each wash of the canal. A curette or small alligator forceps was used to remove remaining cerumen if necessary. Tympanometry and audiometry were repeated after all procedures were completed. Telephone contact was made 1 week later regarding symptoms of acute otitis externa or any other problems. Eighteen children (28 ears) ages 1-10/12 to 11-2/12 years were entered. Four had previously had tympanostomy tubes. At entry, there was no visible TM in 19 ears, 5-10% visible TM in 5 ears, 20% in 1 ear, and 30-40% of the TM in 3 ears. The number of washes needed per ear was: 1 wash--16 ears, 2 washes--8 ears, 3 washes--1 ear, 4 washes--2 ears; washing was stopped in 1 ear because of pain. After irrigation, a curette or forceps was used in 6 ears. Following the procedures, > or = 95% of the TM was visible in 24 ears, and > or = 80% was visible in all ears. Six ears (4 children) with flat tympanograms at entry became normal after irrigation. On audiometry, a conductive loss in 2 ears at entry resolved after irrigation. The mean change in pure tone average (PTA) was -2.9 dB. Three subjects were noted to have hearing losses >5 dB at some frequencies which on review by audiologists were deemed non-significant. No perforations of the TM occurred. There were no reports of otitis externa or any other adverse events occurring after leaving the clinic. We found the OtoClear Safe Irrigation System to be safe and effective in our small sample of children. It was well tolerated in most and provided a non-traumatic method for the removal of obstructing cerumen.

A prospective comparison of performance of biopsy forceps used in single passage with multiple bites during upper endoscopy.

A single biopsy is usually obtained for each passage of a biopsy forceps. It was hypothesized that multiple bites per passage might improve the quantity and quality of tissue obtained, without significant artifacts. This hypothesis was tested in a prospective, pathologist-blinded study using different forceps. Forty consecutive patients who underwent elective upper endoscopy were included. Five different forceps were used in six different ways, varying in the number of bites taken per passage. Two pathologists, who were blinded to the type of biopsy forceps used, evaluated the specimens according to the parameters of maximum weight (mg), size of largest fragment (mm), depth, squash artifact, adequacy, and overall rating. A total of 240 biopsy specimens were obtained. The Microvasive Multibite and Megabite forceps obtained specimens with the maximum weight (P<0.05) and the largest size (P<0.05), respectively. Alligator forceps were able to obtain specimens significantly larger in size than the oval-shaped forceps (P<0.05). The Olympus FB-24K forceps performed best in both the adequacy score and the overall rating score (P<0.05). Forceps with a needle, or the Multibite forceps, allow more biopsies to be taken per passage and improve the quality of tissues obtained. "Needleless" forceps can be used to obtain two samples per passage through the endoscope that are as good as when only one sample is collected. This approach can save time, and causes no significant damage to the biopsy specimens.

Jéjunostomie endoscopique percutanée (JEP)

While percutaneous endoscopic gastrostomy (PEG) today is a well established standard method for enteral nutrition, direct puncture of the jejunum is rarely performed even by experienced endoscopists.Such a direct puncture of the jejunum for percutaneous enterostomy is indicated if the stomach is no longer accessible (esophagectomy, partial or total gastrectomy etc.), cannot be punctured (due to extensive tumour) or if esophageal leakage (anastomotic insuffiency, perforation or fistula) occurs.Some technical aspects have to be respected—in contrast to simple PEG-procedures—to achieve good results and a low complication rate: even if the standard equipment for PEG can be used, application of spasmolytic medication and careful examination of the abdomen for transillumination is mandatory in EPJ. To prevent the needle from slipping out of the bowel after puncture it should be hold tightly by an alligator forceps from inside. Endoscopic and/or x-ray-control of the interior plate is mandatory after pull-through.From January 1990 to September 2002, 180 endoscopic guided direct punctures of the jejunum with subsequent insertion of a tube for nutrition (PEJ) have been performed beneath 1149 “normal” PEGs. Technical failure was seen in 8% (14/180), multiple attempts were necessary in 11% (20/180). Mild complications occurred in 10% (16/166); 1.8% (3/166) of the patients showed signs of intermittent local peritonitis. 2.4% (4/166) had to be operated again due to severe complications, mortality was 1.8% (3/166).Although the complication rate in EPJ is slightly higher than in PEG, complications can be kept low by careful indication and correct technique. In comparison to open operative techniques, endoscopic direct puncture of the jejunum represents a safe and effective alternative to conventional methods with significantly lower risk and low invasiveness.

Tooth Extraction From the Distal Bronchus 12 Days After Traumatic Aspiration: Extraction of a Chronically Aspirated Tooth

Tooth Extraction From the Distal Bronchus 12 Days After Traumatic Aspiration: Extraction of a Chronically Aspirated Tooth

Stapes surgery: how precisely do different prostheses attach to the long process of the incus with different instruments and different surgeons?

The goal of this study was to compare the attachment of stapes prostheses with differently shaped loops to the long process of the incus. In stapes surgery, the attachment of the prosthesis to the long process of the incus plays an important role concerning the gain in hearing and the development of late complications such as incus erosion and necrosis. Band-shaped and spiral loops have been developed to achieve a broad, firm attachment to the long process of the incus. During stapes surgery, the view at the prosthesis is restricted, making it impossible to evaluate the effects of the differently shaped loops. Gold, steel/Teflon, platinum/Teflon, and two different titanium stapes prostheses were inserted in 30 specially prepared temporal bones by three experienced surgeons using the Fisch technique with the McGee and straight alligator forceps for the crimping of the loops. Photographs were taken with 0- and 70-degree rod lens telescopes at defined views. In all prostheses, a sufficiently firm attachment to the long process of the incus was achieved. The attachment of band-shaped loops proved to be better with the straight alligator forceps. The band-shaped loops showed a better contact with the incus than did the wire loops. However, the broad spiral-shaped loops led to a loss of the perpendicular axis of the piston to the long incus process. The geometry of the loop affects the final length of the piston in the vestibule and its angle to the long process of the incus.

Percutaneous endoscopic gastrostomy (PEG)

Percutaneous endoscopic gastrostomy (PEG), although a standard method for long-time enteral nutrition, still leaves uncertainty about details in indication, technique and complications. Based on own experiences (approximately 1000 PEG's and 170 EPJ's in the last 10 years) these topics are discussed. As new indications the PEG for decompression in chronic intestinal obstruction and the questionable relative contraindications ascites, peritoneal carcinosis and Morbus Crohn are discussed. The common thread-pull through-technique is recommended in a slightly modified variation, according to direct puncture techniques of small intestine: the cannulas inserted in the intestine are fixed by an endoscopic alligator forceps, thus facilitating precise puncture and raising safety for the patient due to avoidance of dislocation. As complications local infections, implantation metastases and the buried bumper syndrome have to be mentioned and avoided. Alternative methods for PEG and different exchange systems for more comfort for the patients are discussed finally.

内視鏡下でのフレキシブル・アリゲーター鉗子による犬の上部消化管内異物除去

Using the flexible alligator forceps (FAF) for Dirofilaria immitis foreign bodies in the upper digestive tract were endoscopically removed in 6 canine cases. Small and hard foreign bodies were removed directly by FAF, and large and soft ones were readily removed by a electrocautery wire-loop by the assistance of FAF.

Comparison of laboratory test results before and after surgical removal of heartworms in dogs with vena caval syndrome

Objective To compare results of laboratory tests in dogs with vena caval syndrome before and after surgical removal of heartworms. Design Longitudinal uncontrolled clinical trial. Animals 51 dogs with vena caval syndrome. Procedure Heartworms were removed from the area of the tricuspid valve and pulmonary arteries via venotomy and by use of flexible alligator forceps. Blood samples were obtained before and 10 days after removal of heartworms. Red and white blood cell counts were determined, using an automated cell counter. Biochemical tests were performed, using a dry chemical method. Results 45 dogs survived the procedure, and 6 died or were euthanatized after surgical treatment. After surgery, RBC count and total protein, albumin, calcium, and sodium concentrations increased, and total bilirubin, ammonia, BUN, creatinine, uric acid, and potassium concentrations decreased in dogs that survived. Creatine kinase, L-lactate dehydrogenase, and amylase activities decreased, whereas alkaline phosphatase and ɣ-glutamyltransferase activities and total cholesterol concentration increased. Alanine transaminase activity decreased in 27 dogs but increased in 3 dogs. Changes in test results in dogs that did not survive were similar to those in dogs that did survive. Significant differences were found in RBC count, ɣ-glutamyltransferase activity, and total protein, total cholesterol, BUN, and total bilirubin concentrations before and after removal of heartworms. Clinical Implications Hepatic and renal functions improve rapidly after surgical removal of heartworms, presumably because general and pulmonary circulation is normalized. However, cholestasis may develop, and dogs that survive may need additional treatment to preserve hepatic function. (J Am Vet Med Assoc 1998;213:1134-1136)

Tracheobronchial Foreign Body Removal Using the Flexible Bronchoscope, the Alligator Biopsy Forceps, and the Threading Technique

A foreign body lodged in the tracheobronchial tree can be removed using the rigid or flexible broncho-scope. A variety of catheters and forceps have been designed for this purpose, each using different techniques. We describe a simple technique, applicable if the foreign body has a lumen. An alligator forceps is threaded through the lumen of the foreign body and opened distally to anchor the foreign body between the open jaws of the forceps and the tip of the flexible bronchoscope. The flexible bronchoscope, forceps, and the foreign body are then removed simultaneously as a single unit.

Knotting of a Double Pigtail Stent within the Ureter: An Initial Report

No AccessJournal of UrologyClinical Urology: Case Report1 Nov 1995Knotting of a Double Pigtail Stent within the Ureter: An Initial Report Thierry A. Flam, Nicolas Thiounn, Pierre-Francois Gerbaud, Marc Zerbib, and Bernard Debre Thierry A. FlamThierry A. Flam More articles by this author , Nicolas ThiounnNicolas Thiounn More articles by this author , Pierre-Francois GerbaudPierre-Francois Gerbaud More articles by this author , Marc ZerbibMarc Zerbib More articles by this author , and Bernard DebreBernard Debre More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66801-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Knotting of a Double Pigtail Stent within the Ureter: An Initial Report." The Journal of Urology, 154(5), pp. 1858–1859 References 1 : Ureteral stents. Indications, variations, and complications. Urol. Clin. N. Amer.1988; 15: 481. Google Scholar 2 : Adventitious knots in urethral catheters: report of 5 cases. J. Urol.1989; 148: 1496. Google Scholar Department of Urology, Hopital Cochin, Paris, France.© 1995 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byQuek M and Dunn M (2018) Knot Formation at the Mid Portion of an Indwelling Ureteral StentJournal of Urology, VOL. 168, NO. 4 Part 1, (1497-1497), Online publication date: 1-Oct-2002.BALDWIN D, JURIANSZ G, STEWART S and HADLEY R (2018) KNOTTED URETERAL STENT: A MINIMALLY INVASIVE TECHNIQUE FOR REMOVALJournal of Urology, VOL. 159, NO. 6, (2065-2066), Online publication date: 1-Jun-1998. Volume 154Issue 5November 1995Page: 1858-1859 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.MetricsAuthor Information Thierry A. Flam More articles by this author Nicolas Thiounn More articles by this author Pierre-Francois Gerbaud More articles by this author Marc Zerbib More articles by this author Bernard Debre More articles by this author Expand All Advertisement PDF downloadLoading ...