Double-ended pigtail polyethylene stents in management of benign and malignant ureteric obstruction.

Surgical urinary diversion for incurable pelvic malignancy has a high morbidity and mortality, and external drainage provides less than ideal palliation. Six patients with ureteric obstruction caused by cancer have been managed by operative or endoscopic insertion of self-retaining polyethylene tubes. These techniques also have applications in non-malignant disease, and the treatment of two patients with benign ureteric stricture is described.     

Esophageal stents for the treatment of malignant Dysphagia in patients with esophageal cancer

Self-expanding metal stents (SEMS) are the current standard for relief of malignant esophageal dysphagia. Self-expanding plastic stents (SEPS) are also used for relief of malignant esophageal dysphagia and as neoadjuvant therapy due to their relative ease of removability. The innovations in design of both SEMS and SEPS have made their use more prevalent in patients with malignant dysphagia. We review the current literature on esophageal stents, including general concepts, indications, contraindications, SEMS and SEPS models, complications and their management, implications of tumor location, cost-effectiveness of stents in comparison with other modalities, and quality of life after stent placement.     

Use of two teflon stents in malignant non-hilar biliary atresia

Insertion of biliary stents in cases of malignant biliary obstruction is a widely accepted method to resolve jaundice. The authors applied two 10 French biliary teflon stents to prolong the drain patency in 32 patients with distal malignant obstruction, thought to be inoperable at the time of intervention. Among the followed, inoperable 23 cases 14 patients died for the time of evaluation. The median survival was 150 days, the median drain patency was 99 days. Cholangitis was the cause of death in three patients. Repeated endoscopic interventions were: transient nasobiliary drainage without drain replacement in two patients and four changes of stents in three patients. In the 13 patients, surviving and wearing their drains at least for 100 days the patency of the double drains was 157 days. These results obtained in the long-time survivors support the comparability of the patency of double teflon stent to that of metalstents. In majority of cases the two teflon drains remained patent until the deaths of patients.     

Use of self-expanding stents in benign and malignant esophageal disease

Of patients with malignant esophageal tumors, more than the half has incurable disease at the time of diagnosis. In such cases, quality of life and ability to swallow should be improved or restored by palliating the process e.g. by inserting esophageal stents. In the recent years, use of covered self-expandable metal stents (SEMS) has led to an increased success rate in the palliative treatment of--mainly malignant--strictures of the esophagus. High occurrence of complications (perforation, bleeding) associated with the use of rigid plastic esophageal stents necessitated the development of flexible stents. First generation self-expandable stents were made of special metal alloys, such as nickel-titanium. In the recent years, self-expandable plastic stents are available, too, offering new alternatives in the palliative treatment of esophageal diseases. In our present review article, we discuss the most important aspects about the use of self-expanding esophageal stents, based on recent clinical observations and data.     

Coronary stents.

In this article we review the early history of the coronary artery stent in clinical cardiology, cite a clinical case and assess the potential role of stents in revascularization in the future.     

Biliary stents.

The management of extrahepatic biliary obstruction has been revolutionized by the development of endoprostheses which can be inserted endoscopically or percutaneously. Advances in the technology of stent insertion and in the stents themselves are likely to increase the therapeutic armamentarium of the endoscopist still further.     

Real-world cost-effectiveness of drug-eluting stents vs. bare-metal stents for coronary heart disease—A five-year follow-up study

Objective

To evaluate the cost-effectiveness of using drugeluting stents (DES) compared to bare-metal stents (BMS) for coronary heart disease (CHD).

Prostatic stents and balloon dilatation.

Prostatic obstruction of urinary flow is a common age-related event resulting in both troublesome symptoms and retention of urine. There have been recent developments in the management of such patients by inserting metallic stents or by balloon dilatation of the prostatic urethra. The role of these treatments as alternatives to surgery is evaluated and some of the difficulties encountered in their usage are described in this article.     

Acute dysphagia of oncological origin. Therapeutic management

Dysphagia is one of the most frequent syndromes in patients with tumours of the head and neck, and the oesophagus. This can be the initial symptom or, more frequently, related to the oncological treatment. We review the most important therapeutic and physio-pathological aspects of acute dysphagia of oncological origin. Deglutition is a complex process in which numerous muscular-skeletal structures intervene under the neurological control of different cranial nerves. The complex neuro-muscular coordination needed for a correct deglutition can be affected by numerous situations, both from the effect of the tumours and from their treatment, basically surgery or radiotherapy. In conclusion, it can be affirmed that for a suitable treatment of oncological dysphagia, a correct initial evaluation and an active treatment are required, since not only the patient's quality of life but, on numerous occasions, the possibility of continuing the treatment and thus maintaining the possibilities of a cure depend on control of the dysphagia.     

PTCD联合胆管支架对恶性梗阻性黄疸姑息性治疗的临床研究

目的 研究经皮肝穿刺胆管引流术(PTCD)联合胆道内金属支架置入作为一种姑息性方法对恶性梗阻性黄疸的治疗价值.方法 2005年1～12月,行PTCD治疗的恶性梗阻性黄疸患者76例.穿刺肝左叶胆管46例,肝右叶胆管36例,同时穿刺6例.减黄3 d后,经引流管行常规胆道造影,30例维持原PTCD外引流,6例改为内外引流,40例置人镍钛形状记忆合金支架并维持PTCD外引流,其中5例行左右肝管双支架同时置入,2例因导丝通过狭窄段困难,于3 d后重试,成功置入支架.结果 1例因胆道大出血于术后8 d死亡,余75例患者治疗后血清总胆红素有39例下降明显,33例呈不同程度的下降,3例仍呈上升趋势.72例患者治疗前后血清总胆红素、直接胆红素差异有统计学意义(P＜0.05).72例患者在皮肤瘙痒、厌食、皮肤黄疸及尿液颜色方面均较术前有不同程度的改善,3例患者无改善,甚至加重.12例发生术后并发症,发生率为15.8%,有6例发生两种或两种以上并发症.随访至2006年4月,有54例患者死亡,排除因术后严重并发症短期死亡1例,平均生存时间为7.6个月,单纯PTCD患者为5.8个月,联合胆道支架置入患者为9.5个月.结论 PTCD联合胆道内金属支架置入作为一种微创介入治疗技术,安全性高,可有效解除恶性胆道梗阻,对于无手术机会且未合并肝细胞性黄疸的恶性梗阻性黄疽患者不失为一种较好的姑息性减黄手段.在生存质量和生存时间两方面,联合胆道支架置入患者均优于单纯PTCD患者.     

Development of a multistage diet for dysphagia

A multistage dysphagia diet was developed by the nutrition and the speech-language pathology sections of an inpatient rehabilitation unit to meet a growing need for a diet that would allow dysphagic patients to eat safely and to progress to a wider variety of foods as their swallowing function improved. The diet was constructed empirically by evaluating all foods on the hospital menu for ease of swallowing. It consisted of five solid-food stages and two liquid stages; thickened liquids were provided for patients unable to manage regular liquids. Menus that offered patients choices among food items were designed for most stages. During planning and implementation of the diet, special attention was given to food production concerns, education of staff and other caregivers, and development of instructional materials for patients leaving the hospital. The diet met its goals of providing dysphagic patients with a maximum number of foods that could be swallowed safely, maintaining or improving nutritional status, avoiding unnecessary tube feeding, and winning the support of patients and caregivers.     

PTCD联合胆管支架对恶性梗阻性黄疸姑息性治疗的临床研究

目的研究经皮肝穿刺胆管引流术（PTCD）联合胆道内金属支架置入作为一种姑息性方法对恶性梗阻性黄疸的治疗价值。方法2005年1～12月，行PTCD治疗的恶性梗阻性黄疸患者76例。穿刺肝左叶胆管46例，肝右叶胆管36例，同时穿刺6例。减黄3d后，经引流管行常规胆道造影，30例维持原PTCD外引流，6例改为内外引流，40例置入镍钛形状记忆合金支架并维持PTCD外引流，其中5例行左右肝管双支架同时置入，2例因导丝通过狭窄段困难，于3d后重试，成功置入支架。结果1例因胆道大出血于术后8d死亡，余75例患者治疗后血清总胆红素有39例下降明显，33例呈不同程度的下降，3例仍呈上升趋势。72例患者治疗前后血清总胆红素、直接胆红素差异有统计学意义（P〈0．05）。72例患者在皮肤瘙痒、厌食、皮肤黄疸及尿液颜色方面均较术前有不同程度的改善，3例患者无改善，甚至加重。12例发生术后并发症，发生率为15．8％，有6例发生两种或两种以上并发症。随访至2006年4月，有54例患者死亡，排除因术后严重并发症短期死亡1例，平均生存时间为7．6个月，单纯PTCD患者为5．8个月，联合胆道支架置入患者为9．5个月。结论PTCD联合胆道内金属支架置入作为一种微创介入治疗技术，安全性高，可有效解除恶性胆道梗阻，对于无手术机会且未合并肝细胞性黄疸的恶性梗阻性黄疸患者不失为一种较好的姑息性减黄手段。在生存质量和生存时间两方面，联合胆道支架置入患者均优于单纯PTCD患者。