Cases reported "Constriction, Pathologic"

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1/9. Placement of a colonic stent by percutaneous colostomy in a case of malignant stenosis.

    We present a patient with disseminated stomach cancer who presented with symptoms of acute obstruction of the splenic flexure of the colon caused by tumor spread. During a first attempt to insert a colon stent through the anus under endoscopic guidance as final palliative therapy, it was not possible to reach the region of the stricture, and iatrogenic perforation of the descending colon occurred, which resolved favorably under conservative management. A second attempt to insert a stent was made via percutaneous puncture of the transverse colon, approaching the region of the stricture by a descending route. The procedure was completed without complications and the patient's symptoms improved. Stent placement via percutaneous puncture of the colon has not previously been described in the literature. It may be an alternate route in cases of proximal strictures in which access through the anus has been unsuccessful even with the aid of endoscopic guidance.
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2/9. Laparoscopic ureteral reimplantation for ureteral lesion secondary to transvaginal ultrasonography for oocyte retrieval.

    Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a highly efficient and minimally invasive method for assisted reproductive techniques. Complications related to this procedure are rare. We report the case of a ureteral stricture secondary to ultrasound-guided follicular puncture for oocyte retrieval that was corrected by a laparoscopic approach. This approach can minimize postoperative pain, the length of hospitalization, and the period of convalescence and should be considered a minimally invasive option in the management of this rare complication of oocyte retrieval.
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3/9. Hepaticogastrostomy by echo-endoscopy as a palliative treatment in a patient with metastatic biliary obstruction.

    A palliative hepaticogastrostomy was performed under endoscopic ultrasound guidance in a patient with inoperable hepatic hilar obstruction, creating an anastomosis between the dilated left hepatic duct and the stomach, to relieve symptoms of cholangitis and to allow biliary drainage. This therapeutic procedure was used as an alternative method of drainage of the biliary tree because endoscopic retrograde cholangiopancreatography was not possible and because the percutaneous metallic stent which had been inserted earlier had become occluded (probably by tumor overgrowth). It was a two-step procedure. In the first step a hepatic duct was punctured through the gastric wall with placement of a plastic stent, which created a fistula between them. In a second step a covered, metallic, self-expandable stent was substituted for the plastic stent to maintain the anastomosis and to improve patency over the medium term. The patient's fever was relieved and the bilirubin level fell; the patient remained asymptomatic at the five-months-follow-up.
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4/9. Endoscopic ultrasound-assisted rendezvous maneuver to achieve pancreatic duct drainage in obstructive chronic pancreatitis.

    patients with mechanical obstruction of the pancreatic duct, which can be caused by chronic pancreatitis, suffer from recurrent attacks of pain and inflammation of the pancreas. We report a novel approach using an endoscopic ultrasound- (EUS-) assisted rendezvous technique, which allows drainage of the pancreatic duct in patients in whom primary management by transpapillary drainage during an endoscopic retrograde cholangiopancreatography (ERCP) procedure has failed. Transgastric puncture of the pancreatic duct was performed using a 19-gauge needle under EUS guidance, and a 0.035-inch guide wire was introduced into the duct and advanced through the papilla. This wire was pulled into the duodenum using a side-viewing duodenoscope. A papillotomy was performed using the standard technique and a plastic prosthesis was introduced. The patient tolerated the intervention well and was discharged with no further complaints. EUS-assisted drainage of the pancreatic duct using a rendezvous technique is an elegant and feasible minimally invasive endoscopic treatment for symptomatic patients with chronic pancreatitis, in whom transpapillary introduction of a catheter is not possible.
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5/9. Complete membranous obstruction of inferior vena cava: case treated by balloon dilatation.

    A 30 year-old male with the budd-chiari syndrome due to complete membranous obstruction to the inferior vena cava was successfully treated by Brockenbrough needle puncture followed by balloon dilatation of the membrane. The procedure produced marked symptomatic relief and excellent haemodynamic and angiographic results. The case is reported to highlight the application of balloon angioplasty in this rare condition.
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6/9. Simple and quick non-invasive evaluation of circulatory condition of cerebral arteries by clinical application of the "Bi-Digital O-Ring Test".

    Using the "Bi-Digital O-Ring Test," generalized abnormal circulation of the distribution of the 3 cerebral arteries at each side of the brain (i.e., anterior cerebral artery, middle cerebral artery and posterior cerebral artery) can be predicted, without any expensive instruments usually in a few minutes. When abnormality was found in the bifurcation area of the common carotid artery by the "Bi-Digital O-Ring Test," there were always abnormal findings of the area of the brain where circulation was coming from either one or both of the anterior or middle cerebral arteries. When abnormal "Bi-Digital O-Ring" response was found at the vertebral artery and posterior cerebral artery representation point, discovered by the author, at the side of the 6th cervical vertebra (corresponding to the entry point of the vertebral artery into the transverse foramen), the areas of the cerebrum, cerebellum and brain stem where circulation is coming from the posterior cerebral artery, basilar artery and vertebral artery were also abnormal. Most of these abnormalities were found to be associated with problems of the cervical vertebrae and spastic muscles of the neck and shoulders and are often reversible. In this study, the author was able to differentiate abnormal brain circulation of any major branch of arteries in the brain due to organic changes or functional reversible changes by relaxing these spastic muscles and improving the circulation of the neck and shoulder area by giving either manual acupuncture, massage, or transcutaneous electrical stimulation. This in turn often improved brain circulation. If it was a functional abnormality, within a few minutes after one of these procedures the "Bi-Digital O-Ring Test" usually showed normal response or improvement. However, if it was an organic abnormality, the abnormality remained. When the supra-orbital arterial blood pressure at both sides of the forehead decreases below 40 or 30 mmHg, most patients develop so-called "Cephalic hypotension Syndrome," which is characterized by sleep disturbance pattern; difficulty in concentration; easy forgetfulness of recent events; irritability; decreased pain threshold with or without depression; spastic skeletal muscles, particularly the neck, shoulder and back areas. All of these symptoms can be explained by decreased circulation to the Nucleus Raphe Centralis Superior (controls sleep and waking pattern), Nucleus Raphe Magnus (serotonin & modulation of pain), Nucleus Reticularis Giganto Cellularis (controls muscle tone), etc. in reticular formation.(ABSTRACT TRUNCATED AT 400 WORDS)
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7/9. Pseudo-budd-chiari syndrome: extrinsic deformity of the intrahepatic inferior vena cava mimicking membranous obstruction.

    budd-chiari syndrome secondary to membranous obstruction of the intrahepatic inferior vena cava is a treatable form of chronic liver disease. I report a patient with portal hypertension in whom distortion of the inferior vena cava by cirrhosis and increased intraabdominal pressure initially suggested this condition. The correct diagnosis was made by obtaining lateral views during inferior vena cavography, which demonstrated a tapered, rather than membranous, obstruction, along with normal hepatic venous anatomy and pressure and markedly increased portal vein pressure during transhepatic puncture with a thin needle. That extrinsic deformity of the inferior vena cava may mimic membranous obstruction has not been emphasized recently. This distinction is important as surgical membranotomy is not indicated in patients with cirrhosis and secondary deformity of the inferior vena cava.
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8/9. Sagittal sinus occlusion, caused by an overlying depressed cranial fracture, presenting with late signs and symptoms of intracranial hypertension: case report.

    A case of delayed signs of intracranial hypertension after open depressed cranial fracture occluding the superior sagittal sinus is reported. Elevating depressed fractures overlying a cranial venous sinus is hazardous. Conservative management of the intracranial hypertension, including repeated lumbar punctures, led to an unimpaired outcome. The options of management of delayed problems caused by traumatic venous occlusion are discussed.
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9/9. Use of a puncture needle for recanalization of an occluded right subclavian vein.

    We report a patient in whom we used a puncture needle to initiate percutaneous recanalization of a chronic occlusion of the junction between the right subclavian vein and the right brachiocephalic vein. Under fluoroscopic guidance, an 18-gauge needle was used to puncture the right subclavian vein. When contrast material injected through the needle confirmed intravascular location, the needle was advanced until it deflected and perforated an occlusion balloon target positioned within the right brachiocephalic vein. This technique may be useful in patients with central venous occlusions that are refractory to traversal using traditional catheter and guidewire techniques.
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