Analysis of longterm survivors with expandable metallic stent inserted for malignant biliary stenosis

Background/Purpose. Some patients with unresectable malignant biliary stenosis can survive for more than 1 year after the insertion of self-expandable metallic stents (SEMS). The aim of this study was to analyze the background of the longterm survivors.Methods. In our study, 111 patients with inserted SEMS were divided into two groups: patients who died within 1 year and patients still alive for more than 1 year. The parameters analyzed were survival rate, survival period, patent period of the inserted SEMS, adjuvant therapy, and complications.Results. The number of those who survived for more than 1 year totaled 24 (21.6%). Their diagnoses were bile duct carcinoma (15/31; 48.4%) and pancreas carcinoma (9/28; 32.9%). There were no survivors with other diseases. The survival period and stent-patent period of the patients with bile duct carcinoma (429.2 days and 589.7 days, respectively) and pancreas carcinoma (270.1 days and 336.4 days, respectively) were significantly longer than those of the patients with other diseases. The specific complication of the longterm survivors was duodenal obstruction.Conclusions. Many patients with bile duct carcinoma and pancreas carcinoma survived for more than 1 year and adjuvant therapy should be performed to improve the survival of those patients.     

泰山黄荆根、叶、果、花中的部分金属元素分析

目的测定泰山黄荆中的部分金属元素。方法湿法消化，应用火焰原子吸收分光光度计，标准曲线法测定。结果Mg、Mn、Fe、Zn、Cu、Na、Ca、K等在根、叶、果、花中的富集程度各不相同，不同元素之间也存在很大差别。结论黄荆中某些元素含量丰富，各部位金属元素含量有较大差异。     

Treatment with a metallic endovascular stent in a patient with iliac venous stenosis due to endometrial cancer

There are few cases, to our knowledge, that report the successful treatment of iliac venous stenosis due to gynecologic malignancies with the use of self- expanding metallic endovascular stents. Our patient, who had right lower limb edema, had iliac lymph node metastases which caused iliac vein stenosis by direct invasion from endometrial cancer. The patient was not considered to be a good surgical candidate. A 10-mm diameter self-expanding metallic endovascular stent was placed in the external iliac vein. The patient’s symptoms of right lower limb edema improved dramatically, and she was discharged at 3 weeks after stent placement. The patient had no further symptoms, with continued resolution of the right leg edema during the 10 months following stent placement, at which time she died from the primary disease. The treatment to this patient with a self-expanding metallic endovascular stent proved to be very efficacious and less stressful than direct venous reconstruction or femorofemoral venous bypass grafting. In addition, this procedure dramatically improved the patient’s quality of life. Received: 10 January 2000 / Accepted: 8 February 2000     

Percutaneous mitral commissurotomy using the metallic valvulotome technique in a critically ill adult

A 25-year-old man presented with cardiogenic shock secondary to rheumatic mitral stenosis. Despite aggressive medical treatment he continued to deteriorate. This report describes the successful use of the metallic valvulotome technique for mitral commissurotomy in the context of a critically ill patient.     

A Case of Aorto-Bronchial Fistula After Insertion of Left Main Bronchial Self-Expanding Metallic Stent in a Patient with Recurrent Esophageal Cancer

We report a case of aorto-bronchial fistula (ABF) caused by a self-expanding metallic stent (EMS) 51 days after insertion into the left main bronchus. The patient presented with left main bronchial stenosis caused by post-operative local recurrence of esophageal cancer. Post-operative radio therapy totaling 40 Gy and post-recurrence radiotherapy totaling 34 Gy were administered, with daily fractions of 2 Gy. Stenosis of the left main bronchus improved slightly, and was followed with insertion of EMS to prevent re-stenosis. The patient experienced massive hemoptysis for 3 days before sudden death. Autopsy revealed the EMS edge perforating the descending aortic lumen. Tumor infiltration and bacterial infection were observed on the wall of the left bronchus, and atherosclerosis was present on the aortic wall around the fistula. It should be noted that the left main bronchus was at considerable risk of ABF after insertion of EMS for malignant stenosis, and prophylactic stent insertion into the bronchus without imperative need must be avoided.     

A rare life-threatening complication of migrated nitinol self-expanding metallic stent (Ultraflex)

The use of self-expanding metallic stents (SEMS) as esophageal endoprosthesis represents an advancement in the palliation of dysphagia from unresectable esophageal carcinoma. However, the problem of stent migration persists. Although most migrated stents have a benign outcome, complications do occur. Rare reports of intestinal obstruction have been confined to the stiff plastic and stainless-steel stents. We report the first case of intestinal obstruction secondary to the pliable Nitinol SEMS (Ultraflex) migration.     

Self-expanding stent insertion for urethral strictures: a 10-year follow-up

OBJECTIVE: To evaluate the safety and efficacy of the Urolume endourethral self-expandable metallic stent (American Medical Systems, MI, USA) in treating urethral strictures, based on a follow-up of> 10 years. PATIENTS AND METHODS: Between November 1989 and June 1990, the Urolume stent was inserted into 15 patients (aged 25-77 years) who had recurrent urethral strictures. The mean duration of stricture before stent insertion was 10.9 years. The patients (all men) were followed using a questionnaire and uroflowmetry, and if necessary, retrograde cysto-urethrography and/or urethroscopy and/or X-ray urodynamics. RESULTS: Two failures were caused by excessive tissue proliferation in the stent, which ended in stent removal or a suprapubic catheter. Another two stents were removed because of discomfort or pain. Two patients developed stenosis in the stent after 7 and 9 years. In the final evaluation only two of the 15 patients were satisfied with their stent. The mean maximum urinary flow rate at the last follow-up was 15 mL/s, and half the patients noted 'stent' incontinence. Lower urinary tract infections, urge and stress incontinence, and discomfort with ejaculation, were all symptoms perceived at the last follow-up. CONCLUSION: The long-term results of the Urolume stent in this study weaken the optimistic early results. Only two of the 15 patients were satisfied with their stent.