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PubMed1991

Pneumatic dilation in patients with achalasia with a modified Gruntzig dilator (Levine) under direct endoscopic control: results after 5 years.

From 1985 to 1990, 62 patients have undergone pneumatic dilatation with the modified Gruntzig (Levine) dilator in the treatment of achalasia. A single dilatation with a 30-mm balloon dilator was successful in 85% of the patients. Nine patients required additional procedures. One elected for operative surgical repair, and eight patients underwent a second dilatation with a 35-mm balloon dilator. One patient required a third procedure with a 40-mm dilator. Two patients developed dysphagia for solids after pneumatic dilatation, and did not demonstrate delay or obstruction to the passage of technetium on follow up study. We have described this syndrome as dysfunctional dysphagia, and believe that it is related to the rapid ingestion of a food bolus, and is relieved by eating smaller portions at a slower rate. This is to be differentiated from reflux esophagitis and/or stricture secondary to reflux. One patient required bougie dilatation of a stricture, and three other patients were treated with omeprazole, ranitidine, or antacids with relief of reflux symptoms. The safety and efficacy of the procedure of pneumatic dilatation under direct endoscopic control with the modified Gruntzig dilator has been demonstrated in patients from 8 to 93 yr old, and in patients who have had prior Heller myotomy.

Adolescent↗
PubMed1989

Properties of the pupillary dilation produced by the humoral factor in the pupillary reflex dilation: an experimental study in the cat.

Physiopharmacological properties of the pupillary dilation produced by the humoral factor in the reflex pupillary dilation were studied in cats anesthetized with ketamine-HC1. Pupillary dilation produced by the humoral factor was separated from that produced by the neural mechanism, ie, sympathetic activation and parasympathetic inhibition, by atropinization of acutely sympathectomized pupil. To evoke the pupillary reflex dilation, the sciatic nerve was stimulated by using a bipolar electrode. The stimulus consisted of trains of 0.5 milliseconds duration rectangular pulses and was given for 5 seconds. The stimulus frequency was usually 50 Hz; high frequency stimuli were more effective to evoke pupillary dilation produced by the humoral factor. The pupillary dilation was recorded with an infrared pupillo-analyzing system. A long latency (about 6 seconds) and long peak latency (about 10 seconds) pupillary dilation was produced by the humoral factor. The threshold of pupillary dilation produced by the humoral factor was always higher than that produced by parasympathetic inhibition. The pupillary dilation produced by the humoral factor was not affected by local application and intravitreal injection of 10(-2) M propranolol-HC1 and 10(-2) M yohimbine-HC1. However, the dilation was markedly inhibited by intravitreal injection of 10(-2) M phenoxybenzamine-HC1 or local application of 10(-2) M bunazosin-HC1.

Animals↗
PubMed1998

Comparison of clinical and morphologic cardiac findings in patients having cardiac transplantation for ischemic cardiomyopathy, idiopathic dilated cardiomyopathy, and dilated hypertrophic cardiomyopathy.

This article compares intergroup and intragroup clinical and morphologic findings in patients with ischemic cardiomyopathy (IC), idiopathic dilated cardiomyopathy (IDC), and dilated hypertrophic cardiomyopathy (HC) undergoing cardiac transplantation (CT). Few previous publications have described findings in native hearts explanted at the time of CT. The explanted heart in 92 patients having CT was examined in uniform manner with particular attention to the sizes of the ventricular cavities and the presence of and extent of ventricular scarring. Of the 92 hearts examined, 47 had IC, 35 had IDC, and 10 had dilated HC. Although considerable degrees of intragroup variation occurred, the mean degree of left ventricular dilatation was similar among the patients with IC, IDC, and dilated HC. All patients with IC had left ventricular free wall scarring more extensive than that involving the ventricular septum, but the intragroup variation in the amounts of scarring was considerable. Nine of the 10 patients with dilated HC also had ventricular wall scarring, but it was more extensive in the ventricular septum than in the left ventricular free wall and involvement of the right ventricular wall also was present. Eight (23%) of the 35 IDC patients also had grossly visible ventricular scars but they were small and only 1 of the 8 had coronary narrowing and that was not in the distribution of the scarring. Narrowing of 1 or more epicardial coronary arteries >75% in cross-sectional area by plaque was present in all 47 IC patients, in 8 of the 35 IDC patients (7 had no ventricular scars), and in none of the 10 dilated HC patients. Coronary angiography was the major clinical tool allowing separation of the IC, IDC, and HC patients. Coronary angiography did not detect narrowing in any of the 8 patients with IDC who were found to have coronary narrowing on anatomic study. Thus, among patients with IC, IDC, and dilated HC having CT, distinctive anatomic features allow separation of patients with IC, IDC, and dilated HC, but within each group considerable variation in left ventricular cavity size and extent of ventricular scarring occurs.

Adult↗
PubMed1997

The relationship between disturbed transit and dilated bowel, and manometric findings of dilated bowel in patients with duodenal atresia and stenosis.

To determine whether dilated bowel proximal to obstruction associated with duodenal atresia and stenosis is related to feeding problems after a surgical correction of obstruction, the authors reviewed retrospectively the degree of bowel dilatation and disturbed transit as well as other clinical features in 18 duodenal atresia and 12 duodenal stenosis patients. A multivariate analysis was conducted to determine the possible correlation among them. The authors also evaluated the physiological function of the dilated bowel in duodenal atresia and stenosis patients (n = 8) by manometry of dilated bowel. The results were as follows. (1) In multivariate analysis, using the degree of disturbed transit as a dependent variable and using other clinical features as independent variables, the presence of postoperative complication and the existence of bowel dilatation 2 weeks after the operation were risk factors for disturbed transit. (2) One or two episodes of phase 3 were found in six of eight measured patients during the recorded period. The most distinctive manometric finding was the low contraction amplitude of both phase 2 and phase 3. These results indicate that dilated bowel was related to disturbed transit during the postoperative period, and that the low contraction amplitude of the dilated bowel was the main pathophysiological feature. The tapering or plication of dilated bowel might be indicated in patients with a markedly dilated bowel.

Constriction, Pathologic↗
PubMed1998

A randomized comparison of dilatation alone versus dilatation plus laser in patients receiving chemotherapy and external beam radiation for esophageal carcinoma.

Most patients with carcinoma of the esophagus have advanced disease at presentation. Since cure is usually not possible, the goal of treatment is the palliation of dysphagia. Palliative modalities include bougies, balloons, stents, tumor probe, laser, surgery, chemotherapy, and radiation. In recent years, combined chemotherapy and radiation has shown promising results. However, the relief of dysphagia is slow and frequently incomplete. We compared the effectiveness of dilatation alone versus dilatation plus Nd-YAG laser therapy for the relief of dysphagia while assessing the role of chemotherapy and radiation as an adjunct to surgery. Fifteen patients with squamous cell carcinoma of esophagus who were deemed fit for intensive chemotherapy and radiation were randomized to receive either dilatation alone (N = 7) or dilatation plus laser (N = 8); the end-point for initial success was the passage of a 45 French Savary dilator, and the relief of dysphagia. At entry, 13 of these 15 patients were judged potentially resectable. However, after chemotherapy and radiation, only 3 of 13 (20%) patients could be offered surgery; the remainder were considered too poor a surgical risk. Follow-up was for 30 months, or until death. Further dilatations were performed as needed for relief of dysphagia. No difference was observed between the laser plus dilatation and the dilatation alone group with respect to the degree of dysphagia, weight record, quality of life index (Karnofsky score), or mortality rate. Our results indicate that in patients undergoing chemotherapy and radiation for esophageal carcinoma, dilatation alone provides adequate palliation of dysphagia, and in these patients, chemotherapy and radiation is a poor adjunct to surgical treatment.

Adult↗
PubMed2002

Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs' guidewire dilating forceps.

UNLABELLED: Percutaneous tracheostomy with single-step dilation technique using Griggs' guidewire dilating forceps (GWDF) is a well-recognized procedure. Recently, Ciaglia has introduced a one-step dilation technique using a curved, gradually tapered dilator, the Ciaglia Blue Rhino (CBR). In a prospective, randomized study, we performed percutaneous tracheostomy in 60 consecutive patients, using either the CBR or the GWDF technique. Postoperatively, all patients had bronchoscopy by a blinded consultant, and stoma characteristics and injuries to the trachea were studied. Mean tracheostomy time (skin incision to insertion of tracheostomy tube) in the two procedures (CBR 7.5 min versus GWDF 6.5 min) was not different (P > 0.05). The GWDF technique was associated with under-dilation and over-dilation of the tracheal stoma, each in almost one-third of patients. In the CBR group, the procedure was associated with a significant increase in peak airway pressure (P < 0.05) in all patients. There were nine cases of tracheal cartilage rupture, three cases of longitudinal tracheal abrasion, and one pneumothorax. Three patients had tracheal in-drawing at the scar site with huskiness of voice at 8 wk after decannulation; however, none had any breathing difficulty. We conclude that the techniques are equally effective in the formation of percutaneous tracheostomy. However, tracheal stoma over-dilation with GWDF and increase in peak airway pressure and rupture of tracheal rings with CBR remain major concerns. IMPLICATIONS: The tracheas of 60 patients were cannulated through an artificial opening by using a single-step dilation technique with Ciaglia Blue Rhino or Griggs' dilation forceps. The techniques were equally effective for cannulation of the trachea. However, Ciaglia Blue Rhino was associated with rupture of tracheal rings in one-third of patients and increased airway pressure in all, whereas the Griggs' technique was associated with under- or over-formation of the tracheal opening, each in one-third of patients.

Adolescent↗
PubMed1995

Cervical dilation from laminaria tents and synthetic osmotic dilators used for 6 hours before abortion.

OBJECTIVE: To compare thick laminaria tents with two synthetic osmotic devices for softening and dilating the cervix before abortions. METHODS: This was a randomized clinical trial comparing cervical dilation by thick laminaria tents with two commercially made devices, 3-mm Hypan and 3-mm anhydrous magnesium sulfate-impregnated plastic tents, used for 6 hours. Subjects were 7-14 weeks pregnant, and all 93 were assigned to devices in permuted randomized groups of three. Physicians and patients were not blinded to the type of device used. Need for a tenaculum for insertions, ease of introduction, cramps, removal ease, hourglassing, achieved dilation, and ease of forced dilation were compared. The effects of parity and gestational length on achieved dilation were also analyzed. RESULTS: Parity did not affect dilation. Significant positive, linear slopes of regression were found for achieved dilation versus weeks of gestation for thick laminaria tents and magnesium sulfate devices but not for Hypan tents. Forcible dilation was easiest with thick laminaria tents and most difficult with magnesium sulfate devices. CONCLUSION: All devices provided safe cervical dilation and softening, but thick tents were most effective.

Abortion, Induced↗
PubMed2000

Comparison of the diameter consistency and dilating force of the controlled radial expansion balloon catheter to the conventional balloon dilators.

OBJECTIVES: Balloon dilation of a luminal narrowing is classically performed with a single-diameter balloon. A new multidiameter balloon that allows three progressively larger, controlled radial expansion diameters of a single-balloon catheter (controlled radial expansion, CRE) has been developed. The purpose of this study was to test the diameter consistency and dilating force at increasing pressure of the CRE balloon-dilating catheter and to compare these features with the conventional balloon-dilating catheters. METHODS: The CRE balloon catheter was compared with the Achiever, Eliminator, and Max Force using in vitro testing to determine their dilating diameters and dilating forces. RESULTS AND CONCLUSIONS: This in vitro study has shown that the new CRE balloon catheter with increasing diameter delivers consistently reproducible and progressively greater dilating force. This dilating force of the CRE balloon catheter at its third and maximum diameter inflation was similar to that of the Max Force TTS and significantly greater than that of the conventional balloon dilators, Eliminator and Achiever.

Catheterization↗
PubMed1995

Percutaneous balloon catheter dilatation of benign ureteral strictures: effect of multiple dilatation procedures on long-term patency.

OBJECTIVE: The purpose of this study was to evaluate the long-term efficacy of multiple percutaneous balloon dilatations of benign ureteral strictures. Percutaneous dilatation of ureteral strictures with a balloon catheter was done as an alternative to open surgical repair. MATERIAL AND METHODS: Twenty-eight benign ureteral strictures (in 23 patients) were dilated. These included 21 postoperative strictures, 18 of which were at ureteroenteric anastomosis, three postradiation strictures, and four strictures of unknown origin. If the stenosis persisted, dilatation was repeated (maximum of four dilatations at 1-month intervals). Patients were reevaluated with sonography at 1-month intervals after stent removal. RESULTS: The procedure was considered a technical success if there was no radiographic evidence of a stricture or if hydronephrosis improved on the sonographic examination. Clinical success was determined by stable or improved renal function. All dilatations were technically successful. Fifteen (54%) of the 28 ureters remained patent 1 month after the final dilatation and removal of the stent. Of these 15, 12 were patent 2 months after stent removal, and only five were free of stenosis at the 9-month follow-up, making overall success 18%. All five of these ureters were in the subgroup of patients with ureteroenteric strictures. CONCLUSION: Balloon dilatation of ureteral strictures is technically successful; however, long-term results are poor. Multiple dilatations are of no benefit in maintaining ureteral patency.

Adolescent↗
PubMed1996

Dilation of proximal esophageal strictures following therapy for head and neck cancer: experience with Savary Gilliard dilators.

BACKGROUND: There is little information on dilation of proximal strictures following surgical and/or radiation therapy for head and neck cancer. We studied the feasibility and efficacy of dilating proximal strictures following therapy for head and neck cancer using Savary Gilliard dilators. METHODS: Twenty-one consecutive patients with proximal strictures resulting from surgery and/or radiation therapy of head and neck cancer were studied. Savary Gilliard dilation was performed using the standard and a modified method. Dysphagia was graded before and after dilation using a 5-point scale. RESULTS: Technical success, dysphagia relief, complications, and duration of relief were noted. Technical success was achieved in 20 (95%) patients. Adequate dysphagia relief was obtained in 15/20 (75%) patients, which lasted for 4-36 weeks (median 14 weeks). There were no perforations, bleeding, or deaths. Four patients required repeat dilation after a median interval of 12 weeks. CONCLUSIONS: Savary Gilliard dilation is a safe and effective method for dilating strictures caused by therapy for head and neck cancer.

Adult↗
PubMedDate not supplied

Assessment of dilation methods in achalasia: large diameter mercury bougienage followed by pneumatic dilation as needed.

In a retrospective study, 33 achalasia patients were treated with dilation therapy using large diameter mercury bougienage (mean, 56 French) and/or pneumatic balloon dilation. Mean follow-up time was 35 months. Mercury bougienage, performed in 20 patients, was successful in 10 (50%) with no complications. Pneumatic dilation was performed as initial therapy or in those having failed previous pharmacologic therapy and/or bougienage. A successful response was achieved in 19 of 23 patients (83%), with a 3.2% complication rate. In addition, in four patients with eventual recurrence of symptoms after initial pneumatic dilation, bougienage was used as a successful alternative to repeat pneumatic treatment. The combined efficacy of both forms of dilation was 88% with a complication rate of 1.4%. These data indicate that mercury bougienage should be considered initial therapy for achalasia in view of its simplicity, safety, and acceptable efficacy, followed by pneumatic dilation if bougienage is unsuccessful. Bougienage also may be considered if eventual recurrent symptoms develop after initially successful pneumatic dilation. Surgery should be utilized only if dilation therapy fails to achieve a satisfactory response.

Catheterization↗
PubMed1992

Out-patient esophageal dilation: an experience in 130 patients using Savary-Gilliard dilators.

Experience of outpatient esophageal dilation using Savary-Gilliard dilators in 130 patients during a 17 month period is reported. The strictures were radiation induced (48), tumoral stenoses (40), anastomotic (16) and due to other causes (26). Both fluoroscopy and endoscopy were used in 58%, endoscopy alone in 23% and fluoroscopy alone in 19% of patients for placement of the guide wire. One hundred and twenty six stricture dilations (97%) were technically successful. Eighty one (62%) patients could be dilated to 14 mm or more. One hundred and nineteen (94%) patients were dilated in one or two sessions. Among the 109 patients who followed up, dilation was successful in providing adequate dysphagia relief in 97 patients and facilitated the performance of other therapies in 9 patients. Major complications included severe continuous chest pain (1 case), hematemesis (2), fever (4) and transient stridor (2). The patient with persistent pain and 9 patients undergoing other therapies required hospitalization. There were no perforations or death. We conclude that esophageal dilation with Savary-Gilliard dilators is safe and effective even in tumors and post-radiation strictures. It can be performed on an outpatient basis in a majority of patients.

Adult↗
PubMedDate not supplied

[Instrumental dilatation of esophageal and gastric stenoses using Gruntzig's catheter and Celestin's dilator. Preliminary results].

The aim of this study was to present the technique of endoscopic dilatation and the preliminary results obtained with 2 new instruments, the Grüntzig balloon catheter, and the Celestin dilator, in patients with esophageal or gastric strictures. The Grüntzig balloon catheter was used 11 times in 7 patients (6 adults and one child aged 1 1/2 year), for the dilatation of severe or irregular strictures of the esophagus (5 cases), the stomach (1 case) and the pylorus (1 case). Partial (4 cases) or complete relief (2) were observed and allowed subsequent use of the Celestin bougies (2 cases), or the introduction of an esophageal prosthesis (1 case). In the child with caustic stricture of the esophagus, dilatation with the Grüntzig balloon-catheter was complicated twice by perforation. In the second case, the perforation was related to the technique used in dilatation and was treated by conservation measures. Endoscopic dilatations with the Celestin bougies were performed in 27 patients with benign (including 9 peptic strictures) or malignant strictures (14 cases, 7 related to esophageal cancer, and 7 to cancer of the cardia). A total of 74 dilatations were performed, attaining a maximum diameter of 16 or 18 mm in one session, in 21 patients (78 p. 100 of the cases). In the case of peptic stricture, the anatomical result was excellent in 8 patients and the functional result good in 7 of 9 cases. In case of malignant stricture, the result was conditioned by the evolution of the tumor; recurrence of dysphagia called for either repeated dilatations (8 cases) or the introduction of an esophageal prosthesis (5 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Dilation treatment for achalasia by Chen's soft (fibrous) dilator. An observation of 233 cases.

From May 1987 to January 1993, 233 patients with achalasia admitted to our hospital had been treated using a self-invented soft (fibrous) esophageal dilator, including 16 patients who failed in Heller's myotomy. 228 (97.85%) patients were dilated by way of mouth, 3 (1.29%) by way of stomach and 2 (0.86%) had had a transthoracic operation because of the rupture of the esophagus due to dilation. 19 (8.15%) came back to have the second dilation and 2 the third dilation. 73 (31.33%) cases were dilated in the out-patient department. In 97.85% of the patients, excellent and good results were obtained, through once, twice or thrice of dilation by way of mouth. No esophageal reflux or any sequela was seen after dilation.

Adolescent↗
PubMed2001

Percutaneous dilational tracheostomy: a comparison of single- versus multiple-dilator techniques.

OBJECTIVE: To compare the safety and efficacy of single- vs. multiple-dilator techniques in the performance of percutaneous dilational tracheostomy. DESIGN: Prospective randomized trial. SETTING: Intensive care units at a level 1 trauma center. PATIENTS: Fifty consecutive patients requiring tracheostomy for airway control or prolonged mechanical ventilatory support. INTERVENTIONS: Patients were randomized to receive a percutaneous dilational tracheostomy by either the single- or multiple-dilator technique described by Ciaglia. MEASUREMENTS AND MAIN RESULTS: Percutaneous dilational tracheostomy was performed using the single-dilator technique in 6:01 +/- 3:03 mins and by the multiple-dilator technique in 10:01 +/- 4:26 mins (p <.0006). There were no statistically significant differences in complication rates between the two techniques. No major complications occurred with either technique. CONCLUSION: The single-dilator percutaneous tracheostomy technique is a safe, cost-effective, and more rapidly performed method for bedside tracheostomy in the intensive care unit.

Adult↗
PubMed2002

Multiple dilator pathways in skeletal muscle contraction-induced arteriolar dilations.

To determine whether nitric oxide (NO), adenosine (Ado) receptors, or ATP-sensitive potassium (K(ATP)) channels play a role in arteriolar dilations induced by muscle contraction, we used a cremaster preparation in anesthetized hamsters in which we stimulated four to five muscle fibers lying perpendicular to a transverse arteriole (maximal diameter approximately 35-65 microm). The diameter of the arteriole at the site of overlap of the stimulated muscle fibers (the local site) and at a remote site approximately 1,000 microm upstream (the upstream site) was measured before, during, and after muscle contraction. Two minutes of 4-Hz muscle stimulation (5-15 V, 0.4 ms) produced local and upstream dilations of 19 +/- 1 and 10 +/- 1 microm, respectively. N(omega)-nitro-L-arginine (10(-4) M; NO synthase inhibitor), xanthine amine congener (XAC; 10(-6) M; Ado A(1), A(2A), and A(2B) receptor antagonist), or glibenclamide (Glib; 10(-5) M; K(ATP) channel inhibitor) superfused over the preparation attenuated the local dilation (by 29.7 +/- 12.7, 61.8 +/- 9.0, and 51.9 +/- 14.9%, respectively), but only XAC and Glib attenuated the upstream dilation (by 68.9 +/- 6.8 and 89.1 +/- 6.4%, respectively). Furthermore, only Glib, when applied to the upstream site directly, attenuated the upstream dilation (48.1 +/- 9.1%). Neither XAC nor Glib applied directly to the arteriole between the local and the upstream sites had an effect on the magnitude of the upstream dilation. We conclude that NO, Ado receptors, and K(ATP) channels are involved in the local dilation initiated by contracting muscle and that both K(ATP) channels and Ado receptor stimulation, but not NO, play a role in the manifestation of the dilation at the upstream site.

Adenosine↗
PubMed1983

[Mechanism of the bile duct dilatation in congenital dilatation of the common bile duct].

Radiographic studies including operative cholangiography, endoscopic retrograde cholangiopancreaticography and percutaneous transhepatic cholangiography were performed in 44 patients with congenital dilatation of the common bile duct. The relation between the maximum transverse diameter of the common bile duct (CBD) as an indicator of the degree of dilatation and various possible factors causing dilatation of CBD was studied. Among these factors, the length of the narrow segment (X) was closely related with the maximum transverse diameter (Y). The relation of these two was expressed by a simple equation; log Y = 0.068X + 1.06 (r = 0.934, p less than 0.001, n = 19) Dilatation of CBD has been successfully produced by narrowing the ductal lumen with a small plastic tube encirculating the distal common bile duct in dogs. Experimental dilatation was quite similar with congenital dilatation. In addition, the relation between the maximum transverse diameter (Y') and the length of the narrow segment (X') was also expressed in the following simple equation; log Y' = 0.060X' + 0.88 (r = 0.972, p less than 0.001, n = 18) The present studies did not support the hypothesis that abnormal junction of the pancreatico-biliary system might be the primary cause of congenital dilatation of CBD. They suggest that the stenosis of the distal CBD in the fetal life may determine dilatation of CBD.

Animals↗