Placement of Covered Self-Expandable Metal Biliary Stent for the Treatment of Severe Postsphincterotomy Bleeding: Outcomes of Two Cases

We report two cases of severe postsphincterotomy bleeding in an adult and a pediatric patient treated, as first options, with available techniques to induce hemostasis without success. Because of persisting bleeding, an expandable, partially covered, metallic stent was placed into the choledocho to mechanically compress the bleeding site. The bleeding was stopped. In the following days, both patients remained hemodynamically stable with no further episodes of bleeding. We believe that the application of a covered metallic stent in a severe postendoscopic-sphincterotomy bleeding, refractory to injection therapy, should be considered to avoid additional interventions, which carry a higher risk of complications, even in pediatric patients

A new tissue acquisition technique in pancreatic cystic neoplasm: endoscopic ultrasound-guided through-the-needle forceps biopsy

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AngioJetTM rheolytic thrombectomy with covered balloon-expandable stent deployment in a superior vena cava syndrome: a case report

The Superior Vena Cava Syndrome (SVCS) is a rare mediastinal syndrome, frequently due to compression by a mediastinal malignant leading to venous flow obstruction through the Superior Vena Cava (SVC) towards the heart. The symptoms may consist of edema of the upper body and distended veins, dyspnea up to a life-threatening condition. Restoring the SVC flow by endovascular means can be beneficial in order to achieve a rapid relief of the clinical symptoms. A 51-year-old male with a recent diagnosis of squamous cell lung tumor diagnosis presented to the emergency department with persistent cough, neck and face swelling, and distended jugular veins on clinical examination. No dyspnea and normal vital parameters were reported. Computed Tomography angiography (CT) examination demonstrated thrombosis of subclavian veins and SVC due to compression by malignancy. Compression also involved the right upper lobar bronchus. Through a percutaneous transvenous right humeral access, phlebography confirmed total occlusion of the right subclavian vein, brachiocephalic venous trunk, and superior vena cava. We performed AngioJetTM (Boston Scientific, Marlborough, MA, USA) rheolytic endovascular thrombectomy. The phlebography demonstrated the unlying hemodynamic stenosis due to the ab-extrinsic compression and underwent stenting with a covered balloon-expandable stent. The final phlebography confirmed the patency of the stent and restoration of venous flow. Although there was a complete recovery of the symptoms, the patient died from respiratory complications caused by malignancy involvement. AngioJetTM mechanical thrombectomy and covered balloon-expandable stent deployment is a useful solution for SVCS to quickly achieve relief of the clinical symptoms. There are few case series where thrombectomy and primary stent placement are studied. Further follow-up studies are needed to understand the patency of treated vessels better

ClearPath-assisted underwater endoscopic mucosal resection of a laterally spreading tumor of the colon

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I programmi a sostegno della transizione al lavoro di giovani con disabilità intellettiva: una integrative review.

L’obiettivo della presente integrative review consiste nel fornire una mappatura dei programmi di transizione scuola-lavoro rivolti a giovani adulti con disabilità intellettiva realizzati nell’ultimo decennio. I programmi discussi in letteratura potrebbero, infatti, informare potenziali percorsi nel contesto italiano. Tramite il processo di revisione sistematica abbiamo inizialmente identificato il divario nella ricerca, maggiormente focalizzata sull’età infantile e adolescenziale che sull’età adulta delle persone con disabilità intellettiva, e in particolare rispetto ai programmi di transizione al lavoro e alla vita adulta. Per far fronte alla necessità di un approfondimento dei programmi basati su studi empirici, è stato impiegato il metodo della integrative review, perchè in grado di contribuire all’individuazione di pratiche educative basate sull’evidenza. L’analisi e la sintesi dei risultati degli studi selezionati hanno consentito di individuare sei ricerche, che sono state inseguito valutate dal punto di vista della qualità. I risultati sono stati discussi e le implicazioni per future ricerche in questo ambito messe in luce, al fine di arricchire il dibattito sui programmi di transizione rivolti a giovani adulti con disabilità intellettiva

The eagle jugular syndrome

The elongation of the styloid process is historically associated with two variants of the Eagle syndrome. The classic one, mainly characterized by pain and dysphagia, and the carotid variant characterized by pain and sometimes by cerebral ischemia. We observed a further variant characterized by a styloid elongation coursing adjacent to the transverse process of C1, causing significant compression of the internal jugular vein

Competing risks and prognostic stages of cirrhosis: A 25-year inception cohort study of 494 patients

Background Morphological, haemodynamic and clinical stages of cirrhosis have been proposed, although no definite staging system is yet accepted for clinical practice. Aim To investigate whether clinical complications of cirrhosis may define different prognostic disease stages. Methods Analysis of the database from a prospective inception cohort of 494 patients. Decompensation was defined by ascites, bleeding, jaundice or encephalopathy. Explored potential prognostic stages: 1, compensated cirrhosis without oesophago-gastric varices; 2, compensated cirrhosis with varices; 3, bleeding without other complications; 4, first nonbleeding decompensation; 5, any second decompensating event. Patient flow across stages was assessed by a competing risks analysis. Results Major patient characteristics were: 199 females, 295 males, 404 HCV+, 377 compensated, 117 decompensated cirrhosis. The mean follow-up was 145 ± 109 months without dropouts. Major events: 380 deaths, 326 oesophago-gastric varices, 283 ascites, 158 bleeding, 146 encephalopathy, 113 jaundice, 126 hepatocellular carcinoma and 19 liver transplantation. Patients entering each prognostic stage along the disease course were: 202, stage 1; 216, stage 2; 75 stage 3; 206 stage 4; 213 stage 5. Five-year transition rate towards a different stage, for stages 1-4 was 34.5%, 42%, 65% and 78%, respectively (P < 0.0001); 5-year mortality for stages 1-5 was 1.5%, 10%, 20%, 30% and 88% respectively (P < 0.0001). An exploratory analysis showed that this patient stratification may configure a prognostic system independent of the Child-Pugh score, Model for End Stage Liver Disease and comorbidity. Conclusion The development of oesophago-gastric varices and decompensating events in cirrhosis identify five prognostic stages with significantly increasing mortality risks