Tracheoesophageal fistula: New option in management

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEE Larger fistulae and those situated lower down e.g. supra carinal cannot be managed by this technique.     

扩张置管治疗癌性复杂性食管狭窄和瘘的近远期疗效观察

目的应用带膜金属支架治疗癌性难治性食管狭窄和瘘,并对近、远期疗效进行观察。方法在电子内镜下应用扩张器和支架置入器,对临床确诊的难治性食管狭窄和(或)瘘的48例患者进行支架置入术。根据病情的不同情况选择不同的治疗方式。结果48例患者共放置支架64个,置管后狭窄处直径由(4.02±1.35)mm增至(15.05±4.02)mm(P<0.01),吞咽困难由3.28±0.42级改善为0.94±0.73级(P<0.01),食管瘘患者瘘口全部闭合。随访1个月及1年有效率分别为100%、74.2%,1年失访共3例,复发共8例经重复治疗缓解。结论内镜直视扩张置管治疗难治性食管狭窄和瘘,操作直观简便,定位准确,成功率较高,近远期效果较好。     

布-加综合征腔内成型术治疗体会

目的 :评价单球囊导管扩张 +内支架置放腔内成型治疗膜性及局限性布 加综合征 ,以探讨此术式的优缺点及适应证。方法 :采用下腔静脉单球囊导管扩张及内支架置放的手术方法对 8例膜性及局限性布 加综合征进行治疗。随访时间 10个月～ 2a。结果 :8例患者均一次性穿刺、扩张成功。阻塞段被扩张至 12mm～ 2 0mm ,行内支架置放腔内成型术后 ,阻塞下方下腔静脉压力从平均 (32± 4 .7)cmH2 O下降至 (19± 3.4 )cmH2 O。随访期内全部患者无复发。结论 :经腔内成型术对于短段闭塞型及重度下腔静脉狭窄型有良好疗效。     

Gastrointestinal haemorrhage due to erosion of the duodenal wall by a biliary stent

Complications from improperly placed biliary stents are not uncommon. Free loose wires from the ends of an uncovered stent can irritate and damage adjacent mucosal surfaces. Effective management can be achieved via percutaneous placement of a second stent to alter the orientation of the original stent.     

Prospects for the research and application of biodegradable ureteral stents: from bench to bedside

Abstract

Ureteral stents are commonly used in urological practices but are frequently associated with patient discomfort, encrustation and stent-related infection. And a second procedure is needed to remove the stent. New biomaterials and designs have been attempted to solve these problems. The development of biodegradable ureteral stent shows promising prospects in future clinical applications. This article reviews the biomaterials and preparation methods commonly used in the present study of biodegradable ureteral stents. To date, none of the technological developments has lead to the ‘ideal’ biodegradable ureteral stent, but much progress has been made in the stent design by improving the physical characteristics and biocompatibility of the biomaterials. The controllability of degradation, the biggest problem faced currently, still needs to be further improved. In the future, the nanotechnology and chemical modification of biomaterials may be able to further optimize the properties of degradation.     

Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer

Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simultaneous duodenal metal stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered metal stent was placed across the duodenal stricture, EUS-CDS was performed. The second case was a 63-year-old man who previously had a covered metal stent placed for malignant biliary obstruction. After removing the previously placed metal stent, EUS-CDS was performed. Then, a duodenal covered metal stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from stent occlusion. EUS-CDS combined with duodenal metal stent placement may be an ideal treatment strategy in patients with pancreatic cancer with both duodenal and biliary malignant obstruction.     

冠心病患者介入治疗前后血管内皮生长因子的变化及其临床意义

目的 检测冠心病患者介入治疗前后血管内皮生长因子（VEGF）的动态变化并探讨其与患者诊断、治疗及预后的关系.方法双抗体夹心酶联免疫法（ELISA）检测冠心病患者介入治疗前后血清VEGF的动态变化.结果 与正常对照组比较,CAD患者术后24 h内血清VEGF水平明显升高（P〈0.01）,血运重建完全患者术后3 d VEGF水平显著降低,不完全血运重建患者术后7 d VEGF水平仍高于正常（P〈0.01）.结论 VEGF的表达与心肌缺血程度相关,监测其动态变化有助于诊断CAD病变程度和观察介入治疗的效果,对冠心病PCI疗法的实行和预后有指导意义.