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Complications of hemodialysis access
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Mia Miller, Prakash Jayanthi, William Oppat
Treatment varies by underlying cause of the arterial steal. If arterial stenosis exists proximal to the AVF, percutaneous transluminal angioplasty (PTA) is the initial treatment of choice. Banding, which has fallen out of favor due to high complication rate of fistula thrombosis, involves suturing a small piece of Teflon/Dacron around the AVF 2 cm distally from the anastomosis, and tightened to a lumen reduction of 4mm.25,46 With banding, blood flow and/or digital blood pressure should be measured intraoperatively in order to precisely control the degree of reduced flow obtained.47 The minimally invasive limited ligation endoluminal-assisted revision (MILLER) procedure is a new modified banding technique. This procedure requires a small 1–2 cm skin incision for placement of a ligature, while utilizing a 4–5 mm diameter endoluminal balloon to achieve and standardize the desired reduction of inflow size.48 The balloon is passed retrograde to the area of dissection, and inflated. The ligature is placed around the artery. Using fluoroscopy, the tightness of the ligature can be measured by visualization of the waist. In several series, Miller et al. noted significant improvement in both steal syndrome and high-flow patients, with 89% of steal patients achieving clinical success with a single procedure. Primary access patency was 52% at 3 months, with 90% secondary patency rate at 24 months. However, subsequent studies by other authors have shown variable outcomes.49
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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Upper GI bleeding is a medical emergency, with many of the causes life-threatening. It may present with haematemesis, melaena and haemodynamic instability. In the presence of chronic liver disease, causes may be from peptic ulceration, gastritis or oesophageal varices. Haemodynamic instability should be promptly corrected with IV fluids and blood products to correct clotting abnormalities. Urgent endoscopy is the investigation of choice, and therapeutic measures such as variceal banding, sclerotherapy or argon plasma coagulation can be undertaken. Medical therapy for variceal bleeding includes reducing splanchnic blood flow using terlipressin and β-blockers. Risk of rebleeding can be assessed by applying a Rockall score, which uses age, haemodynamic stability, comorbidity and diagnosis at endoscopy to risk-stratify patients. Once acute bleeding has been stopped, risk of rebleeding is high, so secondary banding can be undertaken to reduce this risk. Surgical procedures such as transjugular intrahepatic portosystemic shunts can reduce portal pressures and reduce the risk of rebleeding.
Haemorrhoidal Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Austin George Acheson, Oliver Cheong Tsen Ng
A review of 39 studies incorporating 8,060 patients undergoing banding revealed complications in 14%, the most common being pain (5.8%) and haemorrhage (1.7%).32 Pain usually occurs at the time of rubber band ligation (RBL) or a few moments after the ligation. This is usually mild, lasts only for an hour or two and is usually controlled by paracetamol. On rare occasions, if the bands are placed too low and are too painful, it may be necessary for them to be removed, but this is likely to require general anaesthesia. Rare and fatal incidences of pelvic cellulitis have been reported following banding.
Bio-banding in soccer: past, present, and future
Published in Annals of Human Biology, 2022
Chris Towlson, Sean P. Cumming
The application of bio-banding in soccer is increasingly popular (Cumming, Brown et al. 2018; Reeves et al. 2018; Abbott et al. 2019; Bradley et al. 2019; Hill et al. 2020; Romann et al. 2020; Towlson, Macmaster et al. 2020; Lüdin et al. 2021; MacMaster et al. 2021; Moran et al. 2021; Towlson, Abt et al. 2021; Towlson, Macmaster, Gonçalves et al. 2021) and there is growing evidence to supports its use in competition, talent evaluation, and for the design and implementation of training programmes. Further research is, however, required to evaluate the long-term effectiveness of bio-banding, identify and understand the potential mechanisms behind any benefits, and establish best practice and, of course, barriers to its use. Particular attention should be paid to the impact of bio-banding upon coaches and scouts’ evaluations of talent, technical and tactical aspects of performance such as attacking and defensive actions and scanning behaviour. The impact of bio-banding upon performance and challenge in specific phases of play where athletic ability may be more important (e.g., one-on-one and transitions plays) should also be considered. In terms of injury prevention, further research is also required to determine when and how to best adjust training programmes to mitigate the risk of specific injuries and how this varies relative to the distal-to-proximal growth gradient.
Cirrhosis and partial portal thrombosis leading to severe variceal bleeding, an unusual presentation of sarcoidosis
Published in Acta Clinica Belgica, 2022
Marco Moretti, Pierre Lefesvre, Joop Jonckheer
Physical examination revealed an apyretic patient (36.6°C tympanic), with an arterial blood pressure of 117/71 mmHg and a regular heartbeat of 119 bpm. The patient was not icteric. Abdominal examination revealed hepato-splenomegaly with a painless abdomen. Blood analysis showed an increased urea of 123 mg/dL (normal range: 21–43 mg/dL) and creatinine of 1.11 mg/dL (normal range: 0.51–0.95 mg/dL) with an estimated glomerular filtration rate of 53 ml/min (normal values <60 ml/min), a hyperkaliemia of 5.4 mmol/L (normal range: 3.4–4.5 mmol/L), and a hyperlactatemia of 6.5 mmol/L (normal range: 0.7–2.1 mmol/L). Increased liver tests were observed (aspartate and alanine transferase within the normal range, alkaline phosphatase of 993 U/L (normal range: 35–104 U/L), gamma glutamyl-transferase of 421 U/L (normal values <40 U/L), and total bilirubin of 1.24 mg/dL (normal range: 0–1.2 mg/dL) with direct bilirubin of 0.8 mg/dl (normal range: 0–0.3 mg/dL)). Profound microcytic anemia with hemoglobin of 6.4 g/dL (normal range: 11.7–15.1 g/dL) was found. Gastroscopy detected esophageal varices grade II with active bleeding. No clear varices were found within the stomach, but blood clots were visualized on the fundus. Elastic banding was performed. The patient was initially treated with somatostatin, ceftriaxone (2 g qd for 7 days), and a transfusion of two blood units. The patient was admitted to the intensive care unit (ICU) for hemodynamic monitoring.
Surgical treatment of therapy-resistant reflux after Roux-en-Y gastric bypass. A case series of the modified Nissen fundoplication
Published in Acta Chirurgica Belgica, 2020
Jan Colpaert, Julie Horevoets, Leander Maes, Gilles Uijtterhaegen, Bruno Dillemans
Although the RYGB remains the gold standard treatment for GERD in the obese, it does not always offer a permanent solution [6,7]. Up to 22% of patients who underwent a successful RYGB operation still complain about postoperative GERD-related symptoms [6]. In our series we find that a large portion of the reflux symptoms after RYGB are associated with earlier or concomitant gastric banding or supradiaphragmatic herniation of the gastric pouch. Gastric banding either before or after the bypass-operation has a detrimental effect on the LES which can contribute to worsening of GERD [14]. In four out of six patients there was a herniation of the pouch on upper GI series. The altered pressure systems when the gastric pouch herniates into the thoracic cavity also contributes to a reduced functioning of the LES and more gastro-esophageal reflux.