Ductal stent endocarditis resulting in a large aortic pseudoaneurysm

An infant with ductal dependent pulmonary blood flow who underwent neonatal ductal stenting and, 4 months later, developed ductal stent endocarditis due to Streptococcus gallolyticus subsp. pasteurianus was described. The infection was associated with a moderate aortic pseudoaneurysm and the patient was treated with antibiotics as well as surgical aortic pseudoaneurysm repair. This novel and unusual complication of ductal stent placement warrants reporting.     

A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer

AimsSelf-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy.Materials and methodsA Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses.ResultsFive of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2–72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6–not reached).ConclusionThe high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.     

食管缺损经肺组织瓣和金属支架重建后黏膜爬行的光镜和电镜观察

 目的 探讨肺组织瓣修复食管侧壁缺损内衬金属支架的方法进行食管重建的可行性。 方法 选取成年犬12条,切除中段食管,选用右中叶肺组织作为替代物,将金属支架放置于缺损处食管内,用游离的肺组织瓣修补食管缺损。术后行钡餐透视检查及病理学检查,通过光镜和电镜观察黏膜的爬行过程,爬行的新生上皮的超微结构。结果 新生食管复层上皮与肺组织瓣连接紧密,愈合良好。但术后18周腺体和平滑肌的再生均不明显。结论 肺组织瓣内衬金属支架重建食管为食管替代提供了一种新的尝试，作为支撑物其远期效果有待进一步探讨。