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Kheir F, Uribe JP, Thakore S, Majid A. Endoscopic management of patients with excessive central airway collapse: a narrative review. J Vis Surg 2021. [DOI: 10.21037/jovs-21-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Majid A, Ayala A, Uribe JP, Abdelghani R, Patel P, Chee A, Parikh M, Kheir F. Protective Strategies in a Simulated Model When Performing Percutaneous Tracheostomies in the COVID-19 Era. Ann Am Thorac Soc 2020; 17:1486-1488. [PMID: 32609553 PMCID: PMC7640727 DOI: 10.1513/annalsats.202004-372rl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Adnan Majid
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Alvaro Ayala
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | | | - Priya Patel
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Alex Chee
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Mihir Parikh
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Fayez Kheir
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
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Ayala A, Uribe JP, Majid A, Martinez R, Paton A, Abdelghani R, Patel P, Chee A, Parikh M, Kheir F. PARAPNEUMONIC PLEURAL EFFUSION AND EMPYEMA: MICROBIOLOGICAL ASSESSMENT AND TREATMENT STRATEGIES IN A HIGH-VOLUME PLEURAL CENTER. Chest 2020. [DOI: 10.1016/j.chest.2020.09.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Uribe JP, Ayala A, Kheir F, Patel P, Abdelghani R, Paton A, Martinez R, Parikh M, Chee A, Majid A. EARLY CHEST TUBE INSERTION (<24 HOURS) DECREASES TREATMENT FAILURE AMONG PATIENTS WITH COMPLICATED PARAPNEUMONIC EFFUSION AND EMPYEMA. Chest 2020. [DOI: 10.1016/j.chest.2020.08.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sepúlveda E, Ibáñez A, Baeza C, Espíndola M, Sepúlveda G, Maureira M, Uribe JP, Salas C. [Robotic mitral valve repair and closure of atrial septal defect. Report of 13 procedures]. Rev Med Chil 2020; 147:1303-1307. [PMID: 32186638 DOI: 10.4067/s0034-98872019001001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Abstract
Background Robot-assisted minimally invasive heart surgery is an effective alternative when compared with classical approaches. It has a low mortality and postoperative complications and its long-term durability is comparable with conventional techniques. AIM To report short- and long-term results with the use of a robot-assisted transthoracic approach. PATIENTS AND METHODS Review of patients undergoing heart surgery between 2015 and 2019 using a robot assisted minimally invasive technique in a single center. We analyzed demographic characteristics, surgical and early ultrasound results. RESULTS Thirteen procedures were reviewed, nine mitral valve repairs (MVR) in patients aged 61 ± 21 years (seven males) and four atrial septal defect (ASD) closures in patients aged from 24 to 52 years (three men). For MVR, the average extracorporeal circulation and myocardial ischemia times were 120 ± 20.9 and 89 ± 21 minutes, respectively. The median hospitalization was four days. Two cases of MVR had postoperative complications. There was no mortality. All cases showed improvement in their symptoms. Ultrasound findings showed no postoperative mitral insufficiency except in one case. CONCLUSIONS We report very good results in both complex mitral repair and CIA closure, comparable to centers with high standards in minimally invasive robot-assisted heart surgery.
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Affiliation(s)
- Edgardo Sepúlveda
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
| | - Aníbal Ibáñez
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
| | - Cristian Baeza
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
| | - Manuel Espíndola
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
| | - Gustavo Sepúlveda
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
| | - Mauricio Maureira
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
| | - Juan Pablo Uribe
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
| | - Cristian Salas
- Departamento de Cirugía Cardiovascular, Clínica las Condes, Santiago, Chile
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Kral A, Castillo G, Galindo C, Wolff M, Uribe JP, Morong C, Beddings I. [Plantar actinomycetoma in a patient without risk factors]. Rev Chilena Infectol 2020; 36:531-535. [PMID: 31859780 DOI: 10.4067/s0716-10182019000400531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.
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Affiliation(s)
- Alejandro Kral
- Facultad de Medicina, Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago, Chile
| | - Gabriel Castillo
- Facultad de Medicina, Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago, Chile
| | - Carolina Galindo
- Facultad de Medicina, Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago, Chile
| | - Marcelo Wolff
- Facultad de Medicina, Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago, Chile
| | | | - Carla Morong
- Hospital Clínico San Borja Arriarán, Santiago, Chile
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Majid A, Labarca G, Uribe JP, Kheir F, Pacheco C, Folch E, Jantz MA, Mehta HJ, Patel NM, Herth FJF, Fernandez-Bussy S. Efficacy of the Spiration Valve System in Patients with Severe Heterogeneous Emphysema: A Systematic Review and Meta-Analysis. Respiration 2019; 99:62-72. [PMID: 31760389 DOI: 10.1159/000504183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spiration Valve System (SVS) is an alternative for patients with severe heterogeneous emphysema; however, data about efficacy from randomized controlled trials (RCT) are unclear. OBJECTIVES To explore both efficacy and safety of SVS in patients with severe emphysema and hyperinflation. METHODS We included PubMed, EMBASE, Coch-rane database. All searches were performed until August 2019. Only RCTs were included for analysis. Risk of bias was assessed using Cochrane risk of bias tool. A meta-analysis evaluated change in forced expiratory volume in 1 s (FEV1), 6-min walking test (6MWT), residual volume, modified medical research council (mMRC) and Saint George respiratory questionnaire (SGRQ), all-cause mortality, risk of pneumothorax, and risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Quality of the evidence was rated using GRADE approach. RESULTS Four RCTs including 629 subjects were included. SVS showed an overall change of 0.03 L (-0.07 to 0.13, I2 = 90%) in the in FEV1 (L) and a 2.03% (-2.50 to 6.57, I2 = 96%) in the predicted FEV1 (%) compared to baseline; however, studies without collateral ventilation (CV) showed an improvement of 0.12 L (95% CI 0.09-0.015, I2 = 0%), This subgroup also reported better results in SGRQ -12.27 points (95% CI -15.84 to -8.70, I2 = 0%) and mMRC -0.54 (95% CI -0.74 to -0.33, I2 = 0%). We found no benefit in 6MWT mean difference = 4.56 m (95% CI -21.88 to 31.00, I2 = 73%). Relative risk of mortality was 2.54 (95% CI 0.81-7.96, I2 = 0%), for pneumothorax 3.3 (95% CI 0.61-18.12, I2 = 0%) and AECOPD 1.68 (95% CI 1.04-2.70, I2 = 0%). CONCLUSION In patients with severe heterogeneous emphysema and hyperinflation without CV, SVS is an alternative that showed an improvement in pulmonary function, quality of life, and dyspnea score with an acceptable risk profile.
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Affiliation(s)
- Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA,
| | - Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Concepción, Chile
| | - Juan Pablo Uribe
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Pulmonary, Critical Care Medicine and Environmental Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael A Jantz
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, Florida, USA
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, Florida, USA
| | - Neal M Patel
- Division of Pulmonology and Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Felix J F Herth
- Department of Pulmonology and Critical Care, Heidelberg, Germany.,Translational lung Research Center Heidelberg, Heidelberg, Germany
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Uribe JP, Beattie J, Inaty H, Chee A, Parikh M, Majid A. BRONCHOSCOPIC PHOTODYNAMIC THERAPY COMPARED TO CRYODEBRIDMENT FOR MALIGNANT CENTRAL AIRWAY OBSTRUCTION: A SINGLE-CENTER COMPARATIVE STUDY. Chest 2019. [DOI: 10.1016/j.chest.2019.08.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Labarca G, Uribe JP, Pacheco C, Folch E, Kheir F, Majid A, Jantz MA, Mehta HJ, Patel N, Herth FJF, Fernandez-Bussy S. Bronchoscopic Lung Volume Reduction with Endobronchial Zephyr Valves for Severe Emphysema: A Systematic Review and Meta-Analysis. Respiration 2019; 98:268-278. [PMID: 31117102 DOI: 10.1159/000499508] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic lung volume reduction using Zephyr® valves has been recently adopted as a treatment option for patients with severe emphysema without collateral ventilation (CV). OBJECTIVES To assess the efficacy and safety of Zephyr valves in such a population. METHODS Studies were identified from MEDLINE and EMBASE databases. All searches were current until June 2018. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of Zephyr. We defined as outcome: change in forced expiratory volume in 1 s (FEV1), in the 6-min walking test (6MWT), in the St George's Respiratory Questionnaire (SGRQ), and in residual volume (RV). Safety analysis included relative risk (RR) of pneumothorax. We assessed the quality of the evidence using GRADE. RESULTS 7 RCTs reported on Zephyr valves and 5 RCTs included only patients without CV. Zephyr improved FEV1 with a mean difference (MD) of 17.36% (CI, 9.28-25.45, I2 = 78%). Subgroup analysis showed significant FEV1 improvement following Zephyr placement in patients with heterogeneous distribution: MD = 21.78% (CI, 8.70-34.86, I2 = 89%) and 16.27% (CI, 8.78-23.76, I2 = 0%) in patients with homogeneous emphysema. Studies with a follow-up of 3 months reported FEV1 MD = 17.19% (CI, 3.16-31.22, I2 = 89%) compared to studies with a follow-up of 6-12 months, which showed a consistent improvement of FEV1 MD = 17.90% (CI, 11.47-24.33, I2 = 0%). Zephyr also showed improvement of SGRQ, 6MWT, and RV. RR of pneumothorax was 6.32 (CI, 3.74-10.67, I2 = 0%). CONCLUSION In this population, Zephyr valves provided significant and clinically meaningful short-term improvements in either homogeneous or heterogeneous emphysema without CV but with an increase in adverse events.
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Affiliation(s)
- Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile, .,Complejo Asistencial Dr. Victor Rios Ruiz, Los Angeles, Chile,
| | - Juan Pablo Uribe
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fayez Kheir
- Division of Pulmonary, Critical Care Medicine and Environmental Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Jantz
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, Florida, USA
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, Florida, USA
| | - Neal Patel
- Division of Pulmonology and Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Felix J F Herth
- Department of Pulmonology and Critical Care, Heidelberg, Germany
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Martinez-Cano JP, Cortes-Castillo V, Martinez-Villa J, Ramos JC, Uribe JP. Dysnatremia among runners in a half marathon performed under warm and humid conditions. BMJ Open Sport Exerc Med 2018; 4:e000351. [PMID: 29955376 PMCID: PMC6018873 DOI: 10.1136/bmjsem-2018-000351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/30/2018] [Accepted: 05/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Dysnatremia has been associated with sports activity, especially long-distance running and endurance sports. High fluid intake is associated with hyponatremia. This study aims to evaluate dysnatremia and risk factors in half-marathon runners under warm and humid environmental conditions. Methods A cross-sectional study was performed among randomly selected runners in the 2017 Cali half marathon. Runners on diuretic therapy or with a known history of kidney disease were excluded. Participants went through a 2-day assessment. Previous medical history, training history, body mass index and running history were determined in the first assessment. Symptoms of dysnatremia and level of fluid consumption during the race were registered during the second assessment and post-run blood sampling for serum [Na+] was also undertaken. Results 130 runners were included in the study. The complete 2-day assessment was performed on 81 participants (62%) that were included in the final analysis. No cases of hyponatremia were found; instead, there were six cases of asymptomatic hypernatremia (7.4%). This hypernatremia had a statistically significant association with lower frequency (p=0.01) and volume of fluid intake during the race (water: p=0.02, Gatorade: p=0.04). Conclusion Hyponatremia has been associated with high fluid intake in races performed under cool weather, such as the Boston Marathon during spring. In contrast, hypernatremia was found in a half marathon in warm and humid weather, which was associated with lower volume and frequency of fluid intake, suggesting that under warm and humid conditions, a median fluid intake of 900 mL during the race could prevent this event.
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Affiliation(s)
| | | | | | | | - Juan Pablo Uribe
- Center for Clinical Investigations, Fundación Valle del Lili, Cali, Colombia
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Peluso MJ, van Schalkwyk S, Kellett A, Brewer TF, Clarfield AM, Davies D, Garg B, Greensweig T, Hafler J, Hou J, Maley M, Mayanja-Kizza H, Pemba S, Jenny Samaan J, Schoenbaum S, Sethia B, Uribe JP, Margolis CZ, Rohrbaugh RM. Reframing undergraduate medical education in global health: Rationale and key principles from the Bellagio Global Health Education Initiative. Med Teach 2017; 39:639-645. [PMID: 28362131 DOI: 10.1080/0142159x.2017.1301654] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Global health education (GHE) continues to be a growing initiative in many medical schools across the world. This focus is no longer limited to participants from high-income countries and has expanded to institutions and students from low- and middle-income settings. With this shift has come a need to develop meaningful curricula through engagement between educators and learners who represent the sending institutions and the diverse settings in which GHE takes place. The Bellagio Global Health Education Initiative (BGHEI) was founded to create a space for such debate and discussion and to generate guidelines towards a universal curriculum for global health. In this article, we describe the development and process of our work and outline six overarching principles that ought to be considered when adopting an inclusive approach to GHE curriculum development.
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Affiliation(s)
- Michael J Peluso
- a Harvard Medical School , Brigham and Women's Hospital , Boston , MA , USA
| | - Susan van Schalkwyk
- b Stellenbosch University, Centre for Health Professions Education , Tygerberg , South Africa
| | - Anne Kellett
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
| | | | - A Mark Clarfield
- e Medical School for International Health, Ben Gurion University of the Negev , Beer-Sheva , Israel
| | - David Davies
- f Warwick Medical School, University of Warwick , Coventry , United Kingdom
| | - Bishan Garg
- g Dr Sushila Nayar School of Public Health , Sewagram , India
| | | | - Janet Hafler
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
| | | | - Moira Maley
- j The University of Western Australia, The Rural Clinical School of Western Australia , Crawley , Australia
| | | | - Senga Pemba
- l St Francis University College of Health , Ifakara , Tanzania
| | - Janette Jenny Samaan
- m Global Health Learning Opportunities , Association of American Medical Colleges , Washington , DC , USA
| | | | | | | | - Carmi Z Margolis
- e Medical School for International Health, Ben Gurion University of the Negev , Beer-Sheva , Israel
- q Prywes Center for Medical Education, Ben Gurion University Faculty of Health Sciences , Beer-Sheva , Israel
| | - Robert M Rohrbaugh
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
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Llinás A, Vanegas BS, Merchan A, Prada G, Gallardo H, Uribe JP. Nosocomial infections: Aligning strategy and action from mission to outcomes. World Hosp Health Serv 2014; 50:24-29. [PMID: 26502487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Outstanding health care institutions around the world lead, in effect, by setting an example and keeping hospital-acquired infections to a minimum. Behind the apparent simplicity of an indicator hides an enormous complexity. We believe that the difficulty in achieving seemingly simple benchmarks stems from the necessity to perform optimally at different levels of the organization consistently. This challenge can be summarized in a word: alignment. Institutional alignment starts with the mission and must be ubiquitous. Achieving the benchmark illustrates the elusive trait of institutional coherence. We will describe the dimensions and levels at our institution that influence our ability to strive for better indicators in the prevention of nosocomial infections, examine some of the difficulties and provide a few examples of success.
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Catán F, Uribe M, Carvajal C, Cavalleri S, Pizarro F, Uribe JP, Uribe-Echevarría S, López C, Venegas L. [BICAP tumor probe in the palliative treatment of malignant esophageal stenosis]. Rev Med Chil 2000; 128:513-8. [PMID: 11008355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND BICAP tumor probe is a device that consists in an energy source and olives that deliver bipolar electricity. It can be used for the fulguration of esophageal tumors after endoscopic dilatation. AIM To report the experience in the treatment of malignant esophageal stenoses using the BICAP tumor probe. PATIENTS AND METHODS Patients with advanced esophageal tumors in aphagia, that were not candidates for palliative surgery were included in this study. After endoscopic dilatation, the tumor was fulgurated with the BICAP tumor probe. RESULTS Twenty one patients (nine male, aged 43 to 91 years old) were treated with the device. A mean of 1.3 sessions with BICAP were necessary to obtain tumor permeabilization, which was obtained in all patients. One patient died of pneumonia 15 days after the procedure. All other patients were ingesting liquid or semisolid diets after two months of follow up. Mean survival after the procedure was 3.8 months. CONCLUSIONS Electrical fulguration of esophageal tumors is a valid therapeutic alternative in aphagic patients.
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Affiliation(s)
- F Catán
- Servicio de Cirugía, Hospital Salvador, Facultad de Medicina, Universidad de Chile
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