Closure Of Tract Research Articles

A biodegradable polymer plug for liver tract embolization after percutaneous or surgical placement of transhepatic biliary drainage tubes: a feasibility study.

To evaluate the feasibility of liver tract embolization after transhepatic biliary drainage using a biodegradable polymer plug (IMPEDE-FX, Shape Memorial Medical, Santa Clara, CA, USA).In a retrospective observational study, 15 plug embolizations were performed in 13 patients at risk for tract-related adverse events (AEs). Risk factors included coagulopathy, cirrhosis, central bile duct puncture, previous drain-related bleeding, malignant obstruction, large tract diameter, or multilevel strictures. Clinical and imaging follow-up was performed at 24 hours, 3 months, and 6 months. Primary endpoints were technical and clinical success. Technical success was defined as plug deployment in the intended position. Clinical success was defined as the absence of biliary, infectious, or bleeding AEs. To assess clinically occult bleeding or biliary obstruction, periprocedural hemoglobin, hematocrit, and bilirubin levels were compared. Secondary endpoints were plug migration, plug oversizing, and plug visibility on imaging.The technical success rate was 100%. The clinical success rate was 84.6%. There were no infectious or bleeding AEs. In 2 cases where the persistence of biliary congestion was clinically underestimated prior to drain removal, 2 biliary AEs occurred (2 biliocutaneous fistulas including 1 plug migration within 24 hours; 15.4% SIR grade 3 AEs). The median plug oversizing relative to the diameter of the hepatic tract was substantially lower in unsuccessful cases than in successful cases (27% vs. 86%). The plug was visible on ultrasound and CT. On MRI, no plug-related artifacts occurred.The plug could be an option when a non-permanent, precisely deployable device is desired for tract embolization. Adequate plug-to-tract oversizing and biliary decongestion are essential to achieve durable tract closure. Therefore, the plug seems unsuitable for patients with multilevel strictures where complete drainage of the biliary system is not feasible. · The polymer plug can be precisely delivered within the liver tract.. · Plug-to-tract oversizing and biliary decongestion are essential for durable tract closure.. · The plug appears unsuitable for endoscopically incompletely relievable multilevel biliary strictures.. · Thurner A, Giulia Dalla G, Hartung V et al. A biodegradable polymer plug for liver tract embolization after percutaneous or surgical placement of transhepatic biliary drainage tubes: a feasibility study. Rofo 2025; DOI 10.1055/a-2509-5189.

Hepatic and splenic venous access tract closure using the VASCADE vascular closure system following percutaneous intervention in patients with CHD.

Hepatic and splenic venous access are specialised techniques used to perform diagnostic and interventional procedures in the cardiac catheterisation laboratory. Bleeding events are the most commonly reported complication following hepatic or splenic venous access. The VASCADE Vascular Closure System (Cardiva Medical Inc. Santa Barbara, CA) is an approved device for closure of femoral vascular access tracts in patients ≥18 years of age. We report our experience using VASCADE to close the hepatic or splenic venous access site in the cardiac catheterisation laboratory. This is a single centre retrospective review of all patients who had percutaneous hepatic or splenic venous access obtained in the cardiac catheterisation laboratory from March 1, 2022 through October 30, 2023 and underwent tract closure with VASCADE. Ten patients (six male) underwent 16 procedures (median age and weight 3.5 years and 12.5 kg) with 15 hepatic and two splenic veins accessed. Successful closure of the access tracts with VASCADE was performed in all patients. There were no major adverse events related to closure of the access sites with VASCADE. VASCADE can be used following transhepatic and trans-splenic venous access in the cardiac catheterisation laboratory to safely close the access tract and potentially reduce the risk of post-procedural bleeding complications. Further evaluation in a larger cohort of patients is needed to ensure VASCADE is safe for use and provides adequate haemostasis following hepatic or splenic venous access, particularly in children.

Localized Administration of Mesenchymal Stem Cell-Derived Exosomes for the Treatment of Refractory Perianal Fistula in Crohn's Disease Patients: A Phase II Clinical Trial.

Crohn's disease perianal fistulae are often resistant to standard anti-TNF-α therapies. Mesenchymal stem cell (MSC)-derived exosomes are extracellular vesicles that have highly potent anti-inflammatory effects, and the previous phase of this study demonstrated their safety in the treatment of refractory perianal fistulas. To evaluate the efficacy of mesenchymal stem cell-derived exosomes for the treatment of refractory perianal fistulas. Nonrandomized, nonblinded single-center phase II clinical trial. Tertiary university hospital. Twenty-three patients were enrolled, 20 of whom completed the study. Refractory perianal fistula was defined as resistance to at least one course of treatment with anti-tumor necrosis facto-α therapy. After clinical assessment and magnetic resonance imaging, the patients were subjected to general anesthesia, and 5 mL of exosome solution was injected directly into the fistula tracts. The injections were repeated three times at 2-month intervals, and patients were followed monthly for 6 months after the last injection. Tissue samples from the tracts were obtained before each injection and subjected to immunohistopathological assessment. MRI data were obtained before and six months after the last injection. The primary outcome of this study was fistula tract closure on clinical examination and magnetic resonance imaging. The secondary outcome was an improvement in the discharge from the tracts. Fistula tracts were fully closed in 12 (60%) of the patients. Four patients showed clinical improvement, with some tracts remaining open, and four patients were completely resistant to treatment. A total of 43 fistula tracts were treated during the trial, 30 (69.7%) of which showed complete closure. Histopathological analysis revealed substantial reductions in local inflammation and signs of enhanced tissue regeneration. Immunohistochemical analysis of cluster of differentiation-68, 20 and 31 reaffirmed these results. MSC-derived exosomes are safe and effective for treating refractory perianal fistulas in patients with Crohn's disease. See Video Abstract.

Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double-blinded randomized controlled trial.

Prior studies focus primarily on surgical outcomes of anal fistula treatment, such as healing rates, rather than patient-reported outcomes, such as postoperative pain, which could influence surgical choice. To compare pain scores at 6 and 24h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula. Prospective, double-blinded randomized controlled trial. A quaternary hospital in Malaysia. Patients aged 18-75years with high transsphincteric fistulas. Fistula laser closure versus ligation of the fistula tract (LIFT) treatment. Pain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi-square, Fisher's exact test, student t-test, or Mann-Whitney with p<0.05 denoting statistical significance. Fifty-six patients were recruited (laser, n=28, LIFT, n=28). Median pain scores for laser versus LIFT at 6h postoperatively were 1.0 versus 2.0 (Rest, p=0.213) and 3.0 versus 4.0 (Movement, p=0.448), respectively. At 24h, this reduced to 2.5 in both arms at rest (p=0.842) but increased to 4.8 versus 3.5 on movement (p=0.383). Median operative time for laser was significantly shorter (32.5min) than LIFT (p<0.001). Laser treated patients trended toward quicker return to work (10.5 vs. 14.0, p=0.181) but treatment failure was similar (54% vs. 50%, p=0.71). No patients developed postoperative incontinence. Mean SF-36 scores increased from baseline (67.1±17.0; 95% CI 63.6-82.4 vs. 71.3±11.4; 95% CI 64.0-75.0) to 6months postoperatively (77.7±21.0; 95% CI 57.0-80.3 vs. 74.0±14.3; 95% CI 67.6-81.4) regardless of the type of surgery (P>0.05). Patients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy. Laser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL. ClinicalTrials.gov: NCT06212739.

Temporary Ureter Occlusion with Simultaneous Urinary Diversion via a Single-Access Route Using a 4-French Balloon Catheter and a Pigtail Nephrostomy Drainage Catheter.

Background and Objectives: This study evaluated the efficacy and safety of temporary ureteral occlusion combined with urinary diversion using a single-access route created by inserting a balloon catheter through a pigtail nephrostomy drainage catheter. With this approach, we aimed to offer an alternative for patients with ureteral leaks who are suboptimal surgical candidates. Materials and Methods: This retrospective study included nine patients (eight of which were bilateral cases and one was unilateral, totaling seventeen cases) who underwent the surgery between September 2023 and March 2024. The method involved gaining percutaneous access to the pelvicalyceal system, inserting a 4-French Fogarty balloon catheter through a pigtail nephrostomy catheter, and inflating the balloon at the proximal or mid-ureter. Results: All 17 cases achieved technical successful with no major complications. The procedure effectively relieved symptoms associated with urinary leakage in most patients. However, the significant deflation of the balloon catheter occurred in five cases (29.4%), with three (17.6%) experiencing complete deflation. In these five cases, the final balloon size was 5.81 mm (range: 0-8.9 mm), confirming a 25.0% decrease in size from pre- to post-procedure. Ureteral occlusion was 28.3 d long on average (range: 8-57 d). All patients experienced symptom relief during temporary ureteral occlusion. Except for two patients lost to follow-up, three patients showed symptom improvement with only PCN and four patients underwent surgical closure of the fistula tract before or after balloon catheter removal. Conclusions: This study confirms that this approach is safe and effective.

Safety and effectiveness of transsplenic access for portal venous interventions: a single-center retrospective study.

To assess the safety and effectiveness of percutaneous transsplenic access (PTSA) for portal vein (PV) interventions among patients with PV disease. Adult patients with PV disease were enrolled if they required percutaneous catheterization for PV angioplasty, embolization, thrombectomy, variceal embolization, or transjugular intrahepatic portosystemic shunt (TIPS) placement for a difficult TIPS or recanalization of a chronically occluded PV. The procedures were performed between January 2018 and January 2023. Patients were excluded if they had an active infection, had a chronically occluded splenic vein malignant infiltration of the needle tract, had undergone splenectomy, or were under age 18years. Thirty patients (15 women, 15 men) were enrolled. Catheterization of the PV through PTSA succeeded for 29 of 30 patients (96.7%). The main adverse effect recorded was flank pain in 5 of 30 cases (16.7%). No bleeding events from the spleen, splenic vein, or percutaneous access point were recorded. Two cases (6.7%) each of hepatic bleeding and rethrombosis of the PV were reported, and a change in hemoglobin levels (mean [SD], - 0.5 [1.4] g/dL) was documented in 14 cases (46.7%). PTSA as an approach to accessing the PV is secure and achievable, with minimal risk of complications. Minimal to no bleeding is possible by using tract closure methods.

Pancreatic Tuberculosis With Duodenal Fistula Presenting as Life-Threatening Gastrointestinal Bleeding

ABSTRACT Pancreatic tuberculosis (TB) warrants heightened suspicion in individuals with pancreatic lesions and risk factors such as HIV, organ transplantation, or pertinent immigration history. We present a 38-year-old man who presented with hemodynamically unstable gastrointestinal bleeding. He was found to have pancreatic TB complicated by a duodenal ulcer with fistula. Following 1 month of antitubercular therapy, he experienced complete resolution of symptoms, healing of the duodenal ulcer, closure of the fistulous tract, and a decrease in the size of the pancreatic lesion as observed on imaging. Our case highlights the importance of early diagnosis and treatment of pancreatic TB.

Respiratory laryngeal coordination during vowel-plosive-vowel transition in shouted speech

This study investigates differences in respiratory-laryngeal coordination between normal and shouted speech in the production of a vowel-plosive-vowel utterance, with the goal toward synthesis of such utterances in loud speech. The results showed that compared to normal condition, shouted speech produced higher intraoral pressure during vocal tract closure, higher airflow at the release of vocal tract closure, increased fundamental frequency and increased duration of glottal closure during the following vowel, and increased respiratory activities. For unvoiced plosives, shouted speech also produced increased voice onset time of the following vowel, but its importance to the perception of shouted speech was small. Computational simulations further showed that such increased voice onset time is likely due to increased maximum vocal fold abduction and/or delayed initiation of vocal fold adduction, which are necessary to avoid voice onset immediately after the release of vocal tract closure in conditions of high subglottal pressure.

A large type I right pulmonary artery to left atrium fistula: underwent successful percutaneous device closure with duct occluder—a rare case report

BackgroundPulmonary artery to left atrium fistula is an unusual structural cause of silent cyanosis. Only less than 100 cases have been reported so far. A high index of clinical suspicion and proper evaluation with bubble contrast echocardiography and cardiac computed tomography (CT) will help to detect this treatable anomaly. The advent of safer percutaneous closure methods has replaced the need for more invasive surgical closure.Case presentationWe report an adolescent boy, who presented with long-standing cyanosis and progressive dyspnea with normal clinical cardiovascular examination. On evaluation, echocardiography and bubble contrast study revealed a large right pulmonary artery (RPA) to left atrium (LA) fistula. Cardiac CT confirmed the same with normal pulmonary venous drainage s/o a large 20 mm Type I RPA LA Fistula. He underwent successful percutaneous closure of the fistula tract with a 22 × 24 mm Cera™ duct occluder via transseptal approach uneventfully.ConclusionOur case enlightens the methodological approach to diagnosing this rare anomaly as well as the feasibility of percutaneous intervention in such cases as it is one of the largest fistula tracts closed percutaneously to date.

Percutaneous Computed Tomography (CT) Fluoroscopy-Guided Biopsy of the Spleen Using Fibrin Glue as a Sealant.

Some authors consider the risk of bleeding an absolute contraindication to percutaneous image-guided splenic puncture. While splenic punctures are mainly performed at specialized centers, no technique for the closure of the puncture tract has been broadly established. The aim of this study was to investigate the effectiveness and safety of a percutaneous image-guided biopsy of the spleen using fibrin glue to plug the tract. A total of 27 requests for splenic image-guided interventions were identified between 2010 and 2021 and considered for inclusion in our retrospective single-center study. Seven patients needed to be excluded, which left twenty patients who underwent a percutaneous computed tomography (CT) fluoroscopy-guided biopsy of a splenic lesion during this period. In all patients, a 17G coaxial needle with an 18G core biopsy needle was used. Diagnostic adequacy and accuracy were evaluated, and complications were classified using the CIRSE classification system for adverse events. Diagnostic adequacy was 100% (20/20), and a median of four samples were collected. Diagnostic accuracy was 80% (16/20). The four off-target samples included one inconclusive finding and three samples of regular spleen tissue. The overall complication rate was 5% (1/20). No mild (grade 1-2) or moderate (grade 3-4) complications occurred. One severe (grade 5-6) complication occurred. Although controversial and potentially high-risk, diagnostic percutaneous biopsies of the spleen appear to be relatively safe with the use of fibrin glue to seal the tract.

Le statut mono ou bi-phonématique des prénasales en Ulund

Monophonematic or Biphonematic Status of Prenasals in Ulund&#x0D; The manɟaku group is a linguistic group that so far includes 15 dialects: ucuur, uɟool, utufan, ubok, ubuj, ujang, uciban-ukan, usiis, uteer, useerar, ulëkës, ubo- mat, uñoob-utam, uyu and ulund. The ulund language of the manɟaku group is taken as a sample in this inquiry. Its speakers call each other the Balund. The latter are thought to be originated in Guinea Bissau, and their main area of concentration is in pəlund, from which the name of the language's speakers is derived. The Balund began migrating from Guinea Bissau to Senegal in colonial times, due to the abuse they suffered in Portuguese lands. They settled in the southern part of Senegal, notably in the Ziguinchor and Kolda regions. It should be noted that despite their distinguisehd Islamization, the Balund remain very attached to their language and are close to their ancient cults and traditions.Our knowledge of Ulund speech is fragmentary, focusing on specific aspects of the language such as the study of nominal classes, the study of the pronominal system, the study of the verb, etc. We note that there are no in- depth studies of the phonetic system, hence the motivation for the study of ulund complex consonants in this article. Consonants are articulations produced with a total or partial obstruction at any point in the vocal tract. Consonants are a highly heterogeneous set of sounds, both articulatory and acoustic. The type of constriction in the vocal tract distinguishes an occlusive consonant from a constrictive consonant. Occlusives are characterized by a silence resulting from the complete closure of the vocal tract (occlusion) at a well-defined point. The fricatives, among the constrictives, are characterized by aerodynamic frictional noises created by turbulent airflow at a point in the vocal tract, presenting a strong constriction at the place of articulation. The mi-nasals are combinations of oral consonants (occlusive or constrictive) + nasal consonants (consonant produced with the lowering of the soft palate).The question of the interpretation of prenasals in many languages, particularly African languages, has already been the subject of a multitude of analyses. This study, which is intended as a modest contribution, in no way claims to list all the specific features of the West Atlantic languages already studied. Our aim is rather to give an overview of what is already known in this field, focusing on the phonetic aspect, so that our young students, when describing a new language of the Niger Congo sub-group, are not obliged to invest a great deal of effort and time on questions which have already been dealt with and answered.

Camposampiero tubeless percutaneous nephrolithotomy (tPCNL): Easy, quick, effective, safe.

To describe our technique to perform tubeless percutaneous nephrolithotomy (tPCNL) using hemostatic matrix (i.e. Floseal®) for the closure of the percutaneous tract, developed through the experience gained in our endourology specialized center. To evaluate the procedure efficacy and safety. tPCNL performed in our center with Floseal® application from February 2017 to December 2019 were retrospectively reviewed. Clinical and surgical data were collected in order to evaluate the success of the procedure and possible complications. Camposampiero technique is reported in detail. Sixty-nine patients (45 males, mean age 58 years old) were included. In all patients the procedure was completed successfully and in 88% of subjects no further treatments were necessary; a low complication rate (6.9%) was reported. In our experience, tPCNL with Floseal application is feasible, safe, and effective.

A phase IB/IIA study of ex vivo expanded allogeneic bone marrow–derived mesenchymal stem cells for the treatment of rectovaginal fistulizing Crohn’s disease

BackgroundCrohn-related rectovaginal fistulas are notoriously difficult to treat. Studies of mesenchymal stem cells for the treatment of perianal Crohn fistulizing disease have largely excluded rectovaginal fistulas. The aim of this study was to determine the safety and efficacy of mesenchymal stem cells for refractory rectovaginal fistulizing Crohn disease. MethodsA phase IB/IIA randomized control trial was performed in a 3:1, single-blinded study. Patients included were adult women with an anovaginal/rectovaginal fistula in the setting of Crohn disease. Seventy-five million mesenchymal stem cells were administered with a 22G needle after curettage and primary closure of the fistula tract at day 0 and month 3. Adverse and serious adverse events were recorded at post-procedure day 1, week 2, week 6, month 3, month 6, and month 12, along with clinical healing, magnetic resonance imaging, and patient-reported outcomes. ResultsA total of 19 patients were enrolled and treated—15 treatment and 4 control. There were no adverse or serious adverse events related to mesenchymal stem cell therapy. At 6 months, 50% of the treatment group and 0% of the control had complete clinical and radiographic healing; 91.7% of the treatment group had improvement at 6 months with only one patient having a lack of response, whereas only 50% of the control group had improvement at 6 months. ConclusionBone marrow-derived mesenchymal stem cells offer a safe alternative treatment approach for rectovaginal fistulas in the setting of Crohn disease. Complete healing was achieved in half of the patients.

Revolutionizing Fistula Treatment: A Case Series on the Application of Kshara Sutra Therapy

A chronic, abnormal contact between the epithelialized anal canal surface and the perianal skin is known as an anal fistula (fistula-in-ano), which can cause serious morbidity and lower quality of life. Traditional surgical procedures as well as more contemporary ones, like the application of fibrin glue, a plug, or closure of the intersphincteric fistula tract, are available as treatment options (LIFT). These conventional techniques, however, may have varying degrees of efficacy, and some may be connected to the risk of incontinence. The Kshara Sutra, an antiquated Ayurvedic parasurgical procedure, was used to treat a case series of 10 patients with a range of anal fistulas, ranging in complexity from simple to complex presentations. Patients in the cases range in age from 22 to 55, both male and female. Despite variations in their particular circumstances, all patients had completely healed fistulas following Kshara Sutra treatment. Additionally, this treatment showed promise in simplifying complicated fistulas. These results add to the expanding body of research that supports the use of Kshara Sutra therapy for the repair of anal fistulas, offering a promising, secure, and maybe more effective option than traditional surgical procedures.

Применение «безнефростомной» перкутанной нефролитотрипсии у детей.

Introduction. Currently, percutaneous renal surgery is a common surgical procedure in urologic practice for the treatment of large and staghorn renal stones. Placement of a nephrostomy tube has been well recognized as a standard procedure to provide hemostasis, adequate drainage, and access for additional endoscopic procedures. At the same time, the use of a nephrostomy tube has negative consequences such as discomfort/pain symptom, longer hospital stay and possible urine extravasation. In view of the above, draining of the access tract raises questions in some cases. The aim of the study was effectiveness of tubeless percutaneous nephrolithotripsy in the treatment of urolithiasis in children. Materials and methods. Between 2013 and 2019, 66 patients (aged 1-17 y/o) underwent tubeless percutaneous nephrolithotomy (PNL) at the Department of Pediatric Urology of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology. Patients were divided into three groups depending on the size of the instruments and the way the operation was completed. The first group (n=28) underwent surgery using the mini-PNL technique with the closure of the access tract. The second group (n=21) underwent surgery using the mini-PNL technique in the end of the surgery, moderate bleeding along the tract was detected in order to stop bleeding, a hemostatic matrix with thrombin was introduced. The third group (n=17) underwent surgery using the standard PNL technique and moderate bleeding was also determined in this group with the aim of tubeless completion, a hemostatic matrix with thrombin was introduced. Drainage of the upper urinary tract in the postoperative period was carried out by "JJ"-internal and "J"-external ureteral stents, which were held for up to 14 days. Results. The complete removal of the calculus in one surgical session was similar in all three groups. In the first group there were 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). In the first group it was 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). The need for additional interventions after surgical treatment was 21.4% in the first group, 23.7% in the second and 17.5% in the third group. Febrile fever (persistent temperature 380 C) most often occurred in the first group – in 10.7% of cases, while in the second and third groups this complication was detected in 4.7% and 5.8% of cases, respectively. Gross hematuria in the postoperative period was noted in the group without the use of a hemostatic matrix, averaging 35 (2-115) hours. Conclusion. The proposed tubeless PNL with the use of a hemostatic matrix is indicated for children without bacteriuria, with complete removal of the calculus, in the absence of trauma of the pelvicalyceal system and intensive bleeding. The duration of gross hematuria decreased with the introduction of the matrix in standard tubeless PNL by 51.4% and in mini-PNL by 25.8% compared with the 1-st group

Identification of a novel candidate HSD3B2 gene variant for familial hypospadias by whole-exome sequencing.

Introduction: Hypospadias [MIM: 300633] is one of the most frequent congenital malformations of male external genitalia. The spectrum of genetic variants causing hypospadias is varied, with studies commonly implicating genes critical in the fetal steroidogenic pathway. This is the first genetic study on hypospadias from the Yemen ethnicity and the second to report HSD3B2 mutations in more than one affected individual from the same family. Material and methods: Surgical hypospadias repair was performed on two hypospadias-affected siblings from a consanguineous family. Whole-exome sequencing (WES) was performed to identify the potential pathogenic variant for hypospadias, which was later confirmed by Sanger sequencing. The identified variant was further analyzed for its pathogenicity by using in silico tools such as SIFT, PolyPhen-2, MutationAssessor, MutationTaster, FATHMM, and ConSurf. Results: We identified a novel missense mutation (Chr1:119964631T>A, c.507T>A, p. N169K) in 3β-hydroxysteroid 2-dehydrogenase (HSD3B2) gene by WES. Sanger sequencing confirmed that the variant segregated the disease in the family between the affected and non-affected individuals. Both patients are homozygous, while parents and two unaffected siblings are heterozygous carriers, indicating an autosomal recessive pattern of inheritance. The in silico analysis by all six in silico tools (SIFT, PolyPhen-2, MutationAssessor, MutationTaster, FATHMM, and ConSurf) predicted the variant to be pathogenic/deleterious. Discussion: An abnormal fetal steroidogenic pathway due to genetic influences may affect the development of the male genital tract, including the urethral tract closure and morphogenesis of male genitalia. Furthermore, the pathogenicity of the observed variant in this study, confirmed by multiple in silico tools, characterizes the influence HSD3B2 gene variants may have in the etiology of hypospadias. Conclusion: Understanding of pathogenic manifestation and inheritance of confounding genetic variants in hypospadias is a matter of great concern, especially in familial cases.

Study of right ventricular outflow tract gradient in immediate postoperative period following intracardiac repair for tetralogy of Fallot

ABSTRACT Background: Surgical repair of tetralogy of Fallot (TOF) consists of adequate ventricular septal defect closure and relief of right ventricular outflow tract (RVOT) obstruction to the greatest extent possible. The residual RVOT gradient can be due to dynamic and fixed obstruction, and high gradient is sometimes seen even after a satisfactory RVOT resection often confirmed with intraoperative TransEsophageal Echocardiogram (TEE). Aim: The present study was conducted to study the changes in RVOT residual gradient in the early postoperative period. We analyzed the change in residual gradient by invasive monitoring intraoperatively after separating from cardiopulmonary bypass (CPB) in a case of intracardiac repair (ICR) for TOF and compared the readings 24 h after extubating the patients in intensive care unit (ICU). Materials and Methods: This was an observation study done in the Department of CTVS, Advanced Cardiac Centre, PGIMER, and Chandigarh from February 2018 to March 2019. A total of thirty patients with preoperative diagnosis of TOF were included in the study. After ICR for TOF, postseparation from CPB, RVOT gradient was measured using 23G needle connected to pressure transducer and compared with RVOT gradient measured 24 h postextubating using invasive line kept intraoperatively in pulmonary artery and RVOT. Results: There was a significant decrease in residual RVOT gradient postoperatively in ICU after 24 h of extubating, in comparison to intraoperative postbypass residual RVOT gradient. Postbypass residual RVOT gradient was 11.33 ± 1.39 that decreased to 7.81 ± 1.29 24 h after extubating (P &lt; 0.05). Patients in whom pulmonary valve was preserved had greater postbypass residual RVOT gradient (12.44 ± 1.13) than patients with transannular patch (10.5 ± 0.90). However, both decreased after 24 h of extubating (9 ± 0.7 and 6.9 ± 0.8, respectively). Conclusion: Once satisfactory RVOT resection for fixed obstruction is done and is confirmed using TEE, the residual gradient, if marginally high, can be ignored as residual gradient significantly decreases after extubation and hemodynamic improvement is seen in postoperative period.

V08-11 MID-PERINEAL SCROTAL FLAP FOR THE REPAIR OF URORECTAL FISTULAS: A NEW TECHNIQUE

You have accessJournal of UrologyCME1 Apr 2023V08-11 MID-PERINEAL SCROTAL FLAP FOR THE REPAIR OF URORECTAL FISTULAS: A NEW TECHNIQUE Luis Martinez-Piñeiro Luis Martinez-PiñeiroLuis Martinez-Piñeiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rectourethral fistula (RUF) is the least common but most devastating complication of the treatment of prostate cancer. Herein we describe a new surgical approach that incorporates a partially de-epithelialized mid-perineal scrotal flap (MPSF), used as interposition flap, that can be used in almost all patients with RUF after radiotherapy regardless of having or not a concomitant stricture or contracture of the posterior urethra or bladder neck that might require a simultaneous urethroplasty. METHODS: From March 2019 to March 2021 3 men with complex RFU that had failed previous intent of surgical correction underwent surgical repair by means of the MPSF technique.In all cases the RUF is stented leaving a ureteric catheter inserted through the urethra and exteriorized through the anus.An inverted trapezoidal incision centered over the mid raphe is made in the perineum with the proximal aspect of the lateral incisions starting at the level of the ischial tuberosities. The distal aspect of the trapezoidal flap reaches the mid portion of the scrotum. A mid-perineal scrotal flap (MPSF) is harvested that incorporates all the subcutaneous tissue between the skin and the bulbar urethra following the surgical technique described by Gil-Vernet et al. for the elevation of scrotal skin flaps for urethroplasty. During this maneuver the testicles surrounded by the tunica vaginalis are completely freed and positioned temporarily over the lower abdomen. The complete bulbar urethra is visible and allows resection and closure of the fistulous tract. In case that a urethral stricture is associated with the fistula an anastomotic urethroplasty can be fashioned. To avoid recurrence of the fistula the distal aspect of the MPSF is de-epithelialized and used as interposition flap. RESULTS: The 3 patients with complex rectourethral fistulas were operated upon with the MPSF technique. After a median follow-up of 14 months all the patients are cured. CONCLUSIONS: The MPSF is a straightforward procedure that allows excellent access both to the bulbar urethra and to the surgical plane between rectum and prostate. It does not require a separate incision for the flap harvesting procedure in case it is necessary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e752 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luis Martinez-Piñeiro More articles by this author Expand All Advertisement PDF downloadLoading ...

P427 One Year Follow up of Three Phase IB/IIA Clinical Trials of Ex Vivo Expanded Allogeneic Bone Marrow Derived Mesenchymal Stem Cells for the Treatment of Fistulizing Crohn’s Disease

Abstract Background Mesenchymal stem cells (MSCs) have been used for the treatment of perianal Crohn’s fistulizing disease by direction injection. However, to date, studies have excluded patients with proctitis, anal canal involvement, vaginal involvement, and an ileal pouch in situ. We sought to assess the safety and efficacy of a direct injection of MSCs for the treatment of perianal, rectovaginal, and peripouch Crohn’s fistula(s). Methods Three phase IB/IIA randomized control trials of perianal (n=23), rectovaginal (n=19) and peripouch (n=22) Crohn’s related fistulas were conducted to determine safety and efficacy of MSCs for refractory phenotypes of perianal Crohn’s disease. Crohn’s patients with perianal, rectovaginal, and peripouch Crohn’s fistulizing disease were offered enrollment into a clinical trial. A total of 75 million MSCs were administered with a 22G needle by direct injection after curettage and primary closure of the fistula tract. A repeat injection of 75 million MSCs was administered at 3 months if complete clinical and radiographic healing were not achieved. Adverse and serious adverse events were collected at post procedure day 1, week 2, week 6, month 3, month 6 and month 12. Clinical healing, radiographic healing per magnetic resonance imaging, and patient reported outcomes were assessed at the same time points. Results A total of 64 patients were enrolled and treated; 49 were treatment and 15 were control. There were no adverse or serious adverse events reported related to investigational product. At twelve months, overall combined clinical and radiographic healing was achieved in 70% of perianal, 37.5% of rectovaginal, and 46.2% of ileal pouch fistulas, respectfully. In the control cohorts, 12 month healing was 0%, 0%, and 0% in the three clincial trials respectively. The perianal Crohn’s disease activity index and VanAssche score all significantly decreased in treatment patients at six and twelve months, but not in the control groups. Conclusion Allogeneic bone marrow derived MSCs offer a safe and effective alternative treatment approach for severe phenotypes of perianal fistulizing Crohn’s disease.

P718 A Phase I Study of Ex Vivo Expanded Allogeneic Bone Marrow Derived Mesenchymal Stem Cells for the Treatment of Pediatric Perianal Fistulizing Crohn’s Disease

Abstract Background Background: Mesenchymal stem cells have been used for the treatment of perianal Crohn’s fistulizing disease by direction injection. However, no studies to date have included pediatric patients. Objective To determine safety and efficacy of mesenchymal stem cells for pediatric perianal fistulizing Crohn’s disease. Methods Design: Phase I safety trial Settings Tertiary inflammatory bowel disease referral center Patients Crohn’s patients aged 13-17 with perianal fistulizing disease. Intervention 75 million mesenchymal stem cells were administered with a 22G needle by direct injection after curettage and primary closure of the fistula tract. A repeat injection of 75 million mesenchymal stem cells at 3 months was given if complete clinical and radiographic healing were not achieved. Main outcomes measures Adverse and serious adverse events at post procedure day 1, week 2, week 6, month 3, month 6 and month 12. Clinical healing, radiographic healing per magnetic resonance imaging, and patient reported outcomes at the same time points. Results Results: A total of 7 pediatric patients were enrolled and treated (6 male; median age of 16.7 years). There were no adverse or serious adverse events reported related to investigational product. At six months, 83% had complete clinical and radiographic healing. The perianal Crohn’s disease activity index, Wexner incontinence score, and VanAssche score had all decreased at six months. Limitations Single institution and open label. Conclusion Bone marrow derived mesenchymal stem cells offer a safe, and likely effective, alternative treatment approach for pediatric perianal fistulizing Crohn’s disease.