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RISS 인기검색어
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- 저자 : Mosko, M. (검색결과 5 건)
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Endoscopic Ultrasound-Guided Pancreatic Duct Intervention
Yuto Shimamura,Jeffrey Mosko,Christopher Teshima,Gary R May 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.2
Endoscopic ultrasound-guided pancreatic duct intervention (EUS-PDI) is an emerging endoscopic approach allowing access and intervention to the pancreatic duct (PD) for patients with failed endoscopic retrograde pancreatography (ERP) or patients with surgically altered anatomy. As opposed to biliary drainage for which percutaneous drainage is an alternative following failed endoscopic retrograde cholangiopancreatography (ERCP), the treatment options after failed ERP are very limited. Therefore, endoscopic ultrasound (EUS)-guided access to the PD and options for subsequent drainage may play an important role as an alternative to surgical intervention. However, this approach is technically demanding with a high risk of complications, and should only be performed by highly experienced endoscopists. In this review, we describe an overview of the current endoscopic approaches, basic technical tips, and outcomes using these procedures.
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Ali Alali,Jeffrey Mosko,Gary May,Christopher Teshima 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.2
Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.
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Hirokazu Honda,Jeffrey D. Mosko,Ryosuke Kobayashi,Andras Fecso,Bong Sik Kim,Schoeman Scott,Gary R. May 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.6
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documentedchallenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including dou-ble-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastricERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and hasshown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thor-ough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overviewof EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate ap-plication. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCPwill be discussed.
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Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future
Philip S.J. Hall,Christopher Teshima,Gary R May,Jeffrey D. Mosko 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.2
Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.
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Custodian-based information sharing
Jacobson, V.,Braynard, R. L.,Diebert, T.,Mahadevan, P.,Mosko, M.,Briggs, N. H.,Barber, S.,Plass, M. F.,Solis, I.,Uzun, E.,Byoung-Joon Lee,Myeong-Wuk Jang,Dojun Byun,Smetters, D. K.,Thornton, J. D. IEEE 2012 IEEE communications magazine Vol.50 No.7
<P>Information sharing systems such as iCloud, Dropbox, Facebook, and Twitter are ubiquitous today, but all of them depend on massive server infrastructure and always-on Internet connectivity. We have designed and implemented a sharing system that does not require infrastructure yet supports robust, distributed, secure sharing by opportunistically using any and all connectivity, local or global, permanent or transient, to communicate. One key element of this system is a new information routing model that so far has proven to be as scalable and efficient as the best of the current Internet routing protocols, while operating in an environment more complex and dynamic than they can tolerate. The new routing model is made possible by new affordances offered by information-centric networking, in particular, the open source CCN [1] release. This article describes the new system and its routing model, and provides some performance measurements.</P>
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