Palliation of malignant esophageal strictures: initial results with self-expanding uncovered nitinol coil stents

The purpose of this study was to determine the efficacy of the uncovered coil stents in patients with malignant dysphagia. coiled spring-shaped uncovered self-expanding metallic Esophacoil stents (Instent, Eden Prairie, Minnesota) were placed in 11 patients (9 men and 2 women; age range 38-77 years, mean age 60.5 years) with malignant esophageal strictures and dysphagia, under fluoroscopic guidance. Dysphagia was graded on a scale of 0 to 4 (0 = no dysphagia; 1 = dysphagia to normal solids; 2 = dysphagia to soft solids; 3 = dysphagia to solids and liquids; 4 = complete dysphagia, inability to swallow saliva). Two patients had received radiation therapy, 4 had had chemotherapy, and 5 had had a combination of both radiation an chemotherapy before stent palliation. Control clinical examinations and endoscopic or barium swallow studies were performed every 4 weeks until the patient died. The stents were were tolerated by all patients and were effective in 9 of 11 patients with malignant dysphagia. Complications of the procedure included incomplete opening of the stent in 1 case, migration in 1 case, transient pain in 8 cases, reflux in 3 cases and minor gastrointestinal bleeding in 2 cases. Stent migration in 1 case resulted in surgical intervention and incomplete opening of the stent allowed only partial improvement of dysphagia in 1 case. The quality of life significantly improved in all other patients. Mean survival time of the patients was 73 days (range 34-125 days) and no significant tumor ingrowth was detected during the follow-up period. Insertion of an Esophacoil has a good palliative effect on dysphagia in patients with malignant esophageal strictures with few complications. Although the stent in uncovered, tumor ingrowth and overgrowth were not observed in our study, possibly because of previous treatments

Subclavian artery aneurysm with oesophagoarterial fistula

Aneurysms of the subclavian artery are rare. Fistula formation between the subclavian artery and the oesophagus has been described in aberrant subclavian artery and oesophageal foreign body. However, a fistula between a non-aberrant subclavian artery aneurysm and the oesophagus has not been previously reported. In this report, an unusual case of subclavian artery aneurysm with a fistula to the oesophagus causing intractable haematemesis is presented with the angiographic findings

NASO-BILIARY TUBE IMPACTION DURING SHOCK-WAVE LITHOTRIPSY

Highlights of Quark Matter 95 are discussed

Surgery: A possible risk for hepatitis C in Turkey. (A case control study)

Objective: This study aims to investigate surgical intervention as a risk factor for HCV infection. Methods: Eighty eight HCV positive cases and 182 HCV negative controls were compared with regards to history of operation and transfusion. Results: History of surgical intervention was present in 51 (57.9%) in case group and 78 (42.8%) in control group. The odds ratio was 1.79 (p < 0.05). Most frequent types of operation were gynecologic operation, apendectomy, and heart or lung operations. Conclusion: These results suggest that surgery may be a risk for transmission of HCV in Turkey

Behcet's disease with pulmonary involvement, superior vena cava syndrome, chyloptysis and chylous ascites

Behcet's disease is a chronic multisystem vasculitis of unknown aetiology. This case report describes a patient who applied to the hospital because of dyspnoea, ascites, oedema of lower extremities and recurrent episodes of haemoptysis. For the last 12 yr, he had superior vena cava syndrome (SVCS) and cardiac and pulmonary involvement of Behcet's disease, and biochemical examination of ascite fluid yielded a chylous effusion containing triglyceride 421 mg dl(-1) and cholesterol 49 mg dl(-1). Chyloptysis was also detected by Sudan III stain. The patient died from cardiac tamponade in spite of cardiac fenestration. To the authors' knowledge, this is the first reported case of Behcet's disease with chylous ascites and chyloptysis in the English literature