Endoscopic submucosal dissection (ESD) has been widely used for resection of esophageal neoplastic lesions, but there are still technical challenges in treating large ones. Based on the development of tunneling technique, we report the first series in which the new technique of endoscopic submucosal tunnel dissection (ESTD) was used to remove large lesions in the esophagus. ESTD was attempted in five consecutive patients with esophageal lesions for which resection was indicated. In the operation, once the margin of the lesions had been marked, a submucosal tunnel was created by submucosal dissection from the oral incision to the anal incision. Bilateral resection was then performed to remove the lesion completely. The average length of the five lesions was 5.7 cm, and their extent as a proportion of the whole circumference of the lumen ranged from one third to four fifths. Operative time ranged from 50 minutes to 120 minutes (mean, 77 minutes). En bloc resection with negative lateral and basal margins was achieved in all lesions without complications.
BACKGROUND AND PURPOSE: The ability of the ivy sign on contrast-enhanced T1-weighted MR imaging (CEMR) to reflect cerebral perfusion and postoperative revascularization in Moyamoya disease remains largely unknown. We aimed to compare the capabilities of CEMR and FLAIR. MATERIALS AND METHODS: CEMR, FLAIR, arterial spin-labeling, and DSA were performed in 44 patients with Moyamoya disease. The ivy sign was scored separately on CEMR and FLAIR using the Alberta Stroke Program Early CT Score. The status of leptomeningeal collaterals was scored on DSA. The postoperative Matsushima grade was evaluated at least 3 months after surgical revascularization. RESULTS: Scoring of the ivy sign on CEMR showed excellent interrater reliability, and FLAIR vascular hyperintensity showed moderate interrater reliability. Correlation analyses revealed that DSA scores were more consistent with the CEMR-based ivy sign score (r ¼ 0.25, P ¼ .03) than with FLAIR vascular hyperintensity (r ¼ 0.05, P ¼ .65). The CEMR-based ivy sign score was significantly correlated with CBF in late-Suzuki stage Moyamoya disease (t ¼ À2.64, P ¼ .02). The CEMR-based ivy sign score at baseline was significantly correlated with the postoperative Matsushima grade (r ¼ 0.48, P ¼ .03). CONCLUSIONS: In this study, CEMR outperformed FLAIR in capturing the ivy sign in Moyamoya disease. In addition, the CEMR-based ivy sign score provided adequate information on hemodynamic status and postoperative neovascularization. The current study suggested that CEMR could be considered as an alternative to FLAIR in future studies investigating leptomeningeal collaterals in Moyamoya disease. ABBREVIATIONS: CEMR ¼ contrast-enhanced T1-weighted MR imaging; FVH ¼ FLAIR vascular hyperintensity; MMD ¼ Moyamoya disease; PCA ¼ posterior cerebral artery; EDAS ¼ encephaloduroarteriosynangiosis; FOV ¼ field of view M oyamoya disease (MMD) is an uncommon cerebrovascular disease characterized by chronic progressive occlusion of the terminal portion of the internal carotid artery and its main branches within the circle of Willis. 1,2 In MMD, the perfusion of brain tissue originates from the narrowed ICA, basal moyamoya vessels, leptomeningeal collaterals derived chiefly from the posterior circulation, and transdural collaterals from the external carotid
from the patients' medical records. The data were analyzed using SPSS version 20. A binary logistic regression model was used to check the effect of different factors on the patients' adherence level. Results: Of 310 study participants only 22.3 % (95% CI, 17.4%-26.8%) of heart failure patients reported good adherence to their self-care recommendations. Adherence to self-care recommendation was positively associated with being male in gender (AOR=2.34, 95% CI: 1.18-4.62), good level of heart failure knowledge (AOR =2.49, 95% CI: 1.276-4.856) and absence of chronic comorbid diseases (AOR =2.57, 95% CI: 1.28-5.14). Conclusions: Overall, heart failure patients' adherence to self-care recommendation is poor and selective. Being male in gender, the absence of chronic comorbidity, and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations. It is therefore strategic to plan improving heart failure patients' knowledge about heart failure signs, symptoms and its management, to improve the patients' adherence level.
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