AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.METHODS A systematic review and meta-analysis was performed following the PRISMA process. Pub Med(...AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.METHODS A systematic review and meta-analysis was performed following the PRISMA process. Pub Med(Medline),EMBASE(Excerpta Medical Database),AMED(Allied and Complementary medicine Database),Scopus and online content,were searched for studies reporting on the Ni Ti-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.RESULTS Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2%(95%CI: 94.8%-98.9%; I2 = 5.8%). Pooled complication rate was 27.6%(95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was-2.00 [95%CI:-2.29%-(-1.72%); I2 = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined.Pooled stent migration rate was 4.7%(95%CI: 2.5%-7.7%; I2 = 0%). Finally,tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2%(95%CI: 3.7%-22.1%; I2 = 82.2%). No funnel plot asymmetry to suggest publication bias(bias = 0.39,P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.CONCLUSION The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour展开更多
Background Thalassemic patients demonstrate an increased rate of extracardiae vascular complications and increased carotid wall intima-media thickness （cIMT）, but very low prevalence of coronary artery disease （CAD...Background Thalassemic patients demonstrate an increased rate of extracardiae vascular complications and increased carotid wall intima-media thickness （cIMT）, but very low prevalence of coronary artery disease （CAD）. We investigated the atheroma burden by assessing the coronary artery calcium （CAC） and elMT in these patients. Methods We examined 37 patients with β-thalassemia and 150 healthy control volunteers with multi-detector computer tomography （CT） and ultrasonography to determine CAC score and cIMT, respectively. Results Propensity score matching （C-statistic： 0.88; 95% CI： 0.83-0.93） resulted in 27 pairs of patients; severe CAC was observed in 2 （7.4%） and 0 of β-thalassemia patients and healthy volunteers respectively （P = 0.5）. Median calcium score was 0 （0-0） in β-thalassemia patients and 0 （0-4） in healthy volunteers （P = 0.8）. Median intima-media thickness was higher in β-thalassemia patients compared to control group [0.45 （0.06-0.65） vs. 0.062 （0.054-0.086）; P = 0.04]. Conclusions Patients with β-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.展开更多
BACKGROUND Computer tomography angiography(CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper lim...BACKGROUND Computer tomography angiography(CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper limbs too. It also has increased the possibilities of this scans being reviewed by no specially trained radiologists.This increases the risk of incidental non vascular findings to be missed or misinterpreted. The study is focusing in the frequency of extravascular incidental finding(EVIF) and highlights the importance for both the reporting radiologist and the referring physician recognizing the frequency of EVIFs.AIM To analyse the frequency of EVIF identified on computed angiography(CT) of the upper limb.METHODS A total of 1383 CT angiographic studies of the peripheral arterial system were performed between August 2015 and August 2017. All upper limb CTAs(n = 79)were retrospectively reviewed for the presence of non-vascular incidental findings within the chest, abdomen/pelvis, musculoskeletal system or head and neck. These EVIFs were subsequently grouped into 3 categories based on clinical significance. EVIFs of immediate clinical relevance were included in category A,findings considered indeterminate but most likely benign were placed in category B, while incidental findings of no clinical significance were included in category C.RESULTS Complete imaging datasets were available in 74/79(93.7%). Patientdemographics included 39(52.7%) females and 35(47.2%) males with a mean age of 59 ± 19.5 years(range 19-93 years). A total of 153 EVIFs were reported in 52 patients(70.3%). Of these, 44 EVIFs(28.7%) were found in the chest, 83(54.2%) in the abdomen, 14(9.2%) in the musculoskeletal system and 9(5.8%) in the head and neck. Thirteen EVIFs(8.4%) identified in 11 patients were noted to be of immediate clinical significance(Category A), 50 EVIFs(32.3%) were identified in20 patients and were considered indeterminate but most likely benign, while the remaining 91 EVIFs(59.5%) identified in 21 patients were determined to be of no clinical significance(Category C). One index case of malignancy(1.3%) and four cases of new disseminated metastatic disease(5.4%) were identified.CONCLUSION Our study of upper limb CTA examinations demonstrated a frequency of 8.4%for extravascular incidental findings of immediate clinical significance. We highlight the importance for both the reporting radiologist and the referring physician of the need to recognize the frequency with which EVIFs are identified in the upper limb peripheral arterial system and of the necessity for further clinical and imaging work-up.展开更多
文摘AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.METHODS A systematic review and meta-analysis was performed following the PRISMA process. Pub Med(Medline),EMBASE(Excerpta Medical Database),AMED(Allied and Complementary medicine Database),Scopus and online content,were searched for studies reporting on the Ni Ti-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.RESULTS Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2%(95%CI: 94.8%-98.9%; I2 = 5.8%). Pooled complication rate was 27.6%(95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was-2.00 [95%CI:-2.29%-(-1.72%); I2 = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined.Pooled stent migration rate was 4.7%(95%CI: 2.5%-7.7%; I2 = 0%). Finally,tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2%(95%CI: 3.7%-22.1%; I2 = 82.2%). No funnel plot asymmetry to suggest publication bias(bias = 0.39,P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.CONCLUSION The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour
文摘Background Thalassemic patients demonstrate an increased rate of extracardiae vascular complications and increased carotid wall intima-media thickness （cIMT）, but very low prevalence of coronary artery disease （CAD）. We investigated the atheroma burden by assessing the coronary artery calcium （CAC） and elMT in these patients. Methods We examined 37 patients with β-thalassemia and 150 healthy control volunteers with multi-detector computer tomography （CT） and ultrasonography to determine CAC score and cIMT, respectively. Results Propensity score matching （C-statistic： 0.88; 95% CI： 0.83-0.93） resulted in 27 pairs of patients; severe CAC was observed in 2 （7.4%） and 0 of β-thalassemia patients and healthy volunteers respectively （P = 0.5）. Median calcium score was 0 （0-0） in β-thalassemia patients and 0 （0-4） in healthy volunteers （P = 0.8）. Median intima-media thickness was higher in β-thalassemia patients compared to control group [0.45 （0.06-0.65） vs. 0.062 （0.054-0.086）; P = 0.04]. Conclusions Patients with β-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.
文摘BACKGROUND Computer tomography angiography(CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper limbs too. It also has increased the possibilities of this scans being reviewed by no specially trained radiologists.This increases the risk of incidental non vascular findings to be missed or misinterpreted. The study is focusing in the frequency of extravascular incidental finding(EVIF) and highlights the importance for both the reporting radiologist and the referring physician recognizing the frequency of EVIFs.AIM To analyse the frequency of EVIF identified on computed angiography(CT) of the upper limb.METHODS A total of 1383 CT angiographic studies of the peripheral arterial system were performed between August 2015 and August 2017. All upper limb CTAs(n = 79)were retrospectively reviewed for the presence of non-vascular incidental findings within the chest, abdomen/pelvis, musculoskeletal system or head and neck. These EVIFs were subsequently grouped into 3 categories based on clinical significance. EVIFs of immediate clinical relevance were included in category A,findings considered indeterminate but most likely benign were placed in category B, while incidental findings of no clinical significance were included in category C.RESULTS Complete imaging datasets were available in 74/79(93.7%). Patientdemographics included 39(52.7%) females and 35(47.2%) males with a mean age of 59 ± 19.5 years(range 19-93 years). A total of 153 EVIFs were reported in 52 patients(70.3%). Of these, 44 EVIFs(28.7%) were found in the chest, 83(54.2%) in the abdomen, 14(9.2%) in the musculoskeletal system and 9(5.8%) in the head and neck. Thirteen EVIFs(8.4%) identified in 11 patients were noted to be of immediate clinical significance(Category A), 50 EVIFs(32.3%) were identified in20 patients and were considered indeterminate but most likely benign, while the remaining 91 EVIFs(59.5%) identified in 21 patients were determined to be of no clinical significance(Category C). One index case of malignancy(1.3%) and four cases of new disseminated metastatic disease(5.4%) were identified.CONCLUSION Our study of upper limb CTA examinations demonstrated a frequency of 8.4%for extravascular incidental findings of immediate clinical significance. We highlight the importance for both the reporting radiologist and the referring physician of the need to recognize the frequency with which EVIFs are identified in the upper limb peripheral arterial system and of the necessity for further clinical and imaging work-up.
