Treatment of Malignant Esophageal Fistulas: Fluoroscopic Placement of Esophageal SEMS, Endoscopically-assisted through Surgical Gastrostomy. A Case Report

2016 ◽  
Vol 25 (2) ◽  
pp. 249-252 ◽  
Author(s):  
Gabriel Constantinescu ◽  
Vasile Şandru ◽  
Mădălina Ilie ◽  
Cristian Nedelcu ◽  
Radu Tincu ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Guide Wire ◽  
Subsequent Development ◽  
Covered Stent ◽  
Metallic Stents ◽  
Fistula Formation ◽  
Life Threatening ◽  
Endoscopic Placement ◽  
Surgical Gastrostomy ◽  
Methods Of Treatment

Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035” guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible. Abbreviations: ERCP: endoscopic retrograde cholangio-pancreatography; GI: gastrointestinal; SEMS: self-expandable metallic stents.

Abstract 16257: Giant Left Circumflex (LCx) Coronary Artery Aneurysm (CAA) Presenting as a Cardiac Mass

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ahmad O Aljamal ◽  
Mohamad Raad ◽  
Sachin Parikh
Keyword(s):  
Artery Aneurysm ◽  
Coronary Intervention ◽  
Covered Stent ◽  
Aneurysm Rupture ◽  
Fistula Formation ◽  
Cardiovascular Risk Reduction ◽  
Drug Induced ◽  
Stent Occlusion ◽  
Threatening Condition ◽  
Life Threatening

Introduction: CAAs are a rare but potentially life-threatening condition. Commonly defined as localized dilations greater than 1.5 times the adjacent artery, “giant” CAA (GCAA) is a term used to describe CAAs that have progressed to greater than four times the adjacent artery. Case: A 73-year-old male who presented with acute dyspnea was found to have a 4.5cm epicardial mass on computed tomography angiography (CTA) of the chest. Coronary angiography revealed a large partially thrombosed saccular aneurysm of the proximal LCx with diffuse ectasia of the remaining coronary arteries. He underwent percutaneous coronary intervention (PCI) with the placement of a covered stent from the left anterior descending to the left main artery, traversing and effectively occluding the LCx. He tolerated the procedure and was discharged on clopidogrel and apixaban. Discussion: Due to their insidious nature, CAAs are underdiagnosed and progress undetected. Serious complications include aneurysm rupture and fistula formation. CAAs are most commonly caused by atherosclerosis but have been associated with infectious, rheumatologic, and genetic etiologies. Drug-eluting stents are increasingly implicated in CAAs by the mechanism of direct vessel trauma and drug-induced inhibition of smooth muscle proliferation. The optimal management of CAAs remains unclear. Cardiovascular risk reduction and monitoring are recommended. Invasive management is usually reserved for giant or unstable aneurysms. Surgical resection or repair is conventional but percutaneous methods such as coiling and stent occlusion are increasingly utilized. Our patient underwent a successful vessel and aneurysm occlusion with favorable post-PCI outcomes. Conclusion: GCAAs are extremely rare and understudied. Percutaneous management appears effective in the management of GCAAs, but the study of long-term safety and outcomes is required.

Effectiveness and safety of modern treatment against nausea and vomiting induced by chemotherapy and radiotherapy

2021 ◽  
Vol 14 (1) ◽  
pp. 11-15
Author(s):  
Łukasz Hajac ◽  
Martyna Hajac ◽  
Adam Maciejczyk
Keyword(s):  
Side Effects ◽  
Serotonin Syndrome ◽  
Nausea And Vomiting ◽  
Effective Prevention ◽  
Important Group ◽  
Life Threatening ◽  
Treatment Changes ◽  
Long Acting ◽  
Methods Of Treatment

Nausea and vomiting are one of most frequent side effects of chemotherapy and radiotherapy. Effective prevention and treatment of these symptoms is essential for better quality of life for patients undergoing oncological therapies. Nausea and vomiting can be acute, delayed or anticipatory. Leading mechanisms and methods of treatment are different for each of those. Most often used groups of drugs are: 5-HT3-antagonists, glucocorticosteroids, NK1-antagonists. Another important group are neuroleptics, which are therapy of choice for anticipatory vomiting. Modern antiemetic medications are in most cases safe and effective. But as every treatment it causes risks of adverse events which may be serious and difficult to manage. It applies in particular to long-acting drugs. Most common side effects are headache, constipation and sedation. But more severe or life-threatening symptoms may appear, like intestinal obstruction and serotonin syndrome. Some of the drugs also come with risk of interacting with other treatment. Changes in pharmacokinetics may lead to additional toxicities. In elderly, especially with cardiac disease, in risk of ileus or cachexia these drugs shall be used with caution.

scholarly journals Stricture recanalisation of the distal urether with various endoprothesis

2010 ◽  
Vol 57 (2) ◽  
pp. 61-64 ◽  
Author(s):  
A. Mladenovic ◽  
K. Davidovic ◽  
B. Markovic ◽  
P. Anojcic ◽  
M. Stojadinovic ◽  
...  
Keyword(s):  
Percutaneous Nephrostomy ◽  
Covered Stent ◽  
Metallic Stents ◽  
Metal Stents ◽  
Covered Stents ◽  
Important Place ◽  
Distal Ureter ◽  
Number Of Patients ◽  
Study Results ◽  
New Generation

Introduction: Application of the metallic stents in the interventional uroradioligy is the result of continuous development of the new generation methods percutaneous nephrostomy (PCN), ballon catheter dilatation (BCD), methal and covered stent application. Application of metal stents in the renal canal system was attempted in order to eliminate BCD and PCN - related limitations as well as poor therapeutic results of these methods in a number of etiopathogenic groups of urinary stasis. Years - long application of interventional uroradiology methods, until the development of metallic stengts had shown the following therapeutics facts: PCN is incapable to resolve the cause of urinary obstruction. Permanent good therapeutic BCD results mostly depend on pathohistological aspect of the stricture, metallic stents are most frequently the last choice in therapeutics approch to urinary tract obstructions and their application is directly dependent on previous therapeutics results accomplished by PCN and BCD. In therapeutical sequences new generation of covered stents have important place as method of selection in patients of irreversible uroopstruction of distal ureter. Objective: The main goal of this study was to analyze therapeutics results, advanteges and shortages of insercion plastics and opened metallic endoprothesis, and to analyze results of covered methal applications on the contrary of using older interventional uroradiology methods. Method: Sixthytwo patients with distal urether strictures threated in the Deparment of interventional uroradiology Institute of Radiology Clinical centre of Serbia in Belgrade, participated in the study. Results were analyzed with Person's 2- test, Fisher test and Student T-test. Results: In our study we had highly significant differences in comparison with number of patients and type of stents during the time after recanalization was reached. Also it was highly significant differences according the type of used interventional uroradiology method that treated proliferation and the success of recanalization. Conclusion: Application of covered temporary uretheral stents have number advantages against using generation older permanent methal endoprothesis.

scholarly journals An unusual experience with endoscopic retrograde cholangiopancreatography

2013 ◽  
Vol 04 (04) ◽  
pp. 114-116 ◽  
Author(s):  
Mallikarjun Patil ◽  
Keyur A. Sheth ◽  
C. K. Adarsh ◽  
B. Girisha
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Guide Wire ◽  
Rare Complication ◽  
Endoscopic Retrograde ◽  
Endoscopic Procedures ◽  
Hepatic Hematoma ◽  
Hemorrhagic Complications ◽  
Life Threatening ◽  
Therapeutic Utility

AbstractThe endoscopic retrograde cholangiopancreatography (ERCP) is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.

scholarly journals Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis—Case Report and Literature Review

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 617
Author(s):  
Milica Mitrovic ◽  
Vladimir Dugalic ◽  
Jelena Kovac ◽  
Boris Tadic ◽  
Stefan Milosevic ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Color Doppler ◽  
Abdominal Mass ◽  
Subsequent Development ◽  
Invasive Treatment ◽  
Total Size ◽  
Artery Pseudoaneurysm ◽  
Life Threatening ◽  
Vascular Arcade ◽  
Endovascular Coil Embolization

Pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. In this paper, we present a case of a 74-year-old man, who was admitted to our clinic with a diagnosis of an acute on chronic pancreatitis complicated by walled-off-pancreatic-necrosis, with subsequent development of peripancreatic pseudoaneurysm. After initial conservative management, the patient recovered and was discharged from the hospital. However, he soon returned feeling anxious due to a pulsatile abdominal mass. Abdominal Color–Doppler examination, CT scan, and angiography revealed large pancreatic necrotic collection in the total size of 9 cm, with centrally enhancing area of 3.5 cm that corresponded to pseudoaneurysm originating from the posterior pancreaticoduodenal vascular arcade. Considering the size, location of the pseudoaneurysm, feeding vessel, and poor general patients condition, we opted for minimally invasive treatment. Pseudoaneurysm was successfully managed by endovascular coil embolization, i.e., “sandwich technique”.

scholarly journals Electrochemotherapy in Breast Cancer - Discussion of the Method and Literature Review

Breast Care ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. 409-414 ◽  
Author(s):  
Mateusz Wichtowski ◽  
Dawid Murawa ◽  
Katarzyna Kulcenty ◽  
Karolina Zaleska
Keyword(s):  
Breast Cancer ◽  
Cancer Recurrence ◽  
Locoregional Treatment ◽  
Electric Pulses ◽  
Non Invasive ◽  
Life Threatening ◽  
Late Stages ◽  
Methods Of Treatment ◽  
Cause Of Pain

Breast cancer is the most common cause of skin metastases in women. The probability of their occurrence ranges from about 5% in the entire population to as much as 30% in the late stages of the disease. Although rarely life-threatening, they have a major impact on the quality of life of patients with this diagnosis, being the cause of pain, effusion, ulceration, infection, and psychological discomfort. Available methods of treatment, both local and systemic, often fail to provide adequate control of the disease. A particular challenge seems to be the treatment of those patients with cutaneous metastases who, due to the extent of their metastases, are not eligible for resection, in whom the possibility of radiation therapy has already been used, and in whom systemic therapy is ineffective or contraindicated. A new method providing the opportunity for effective treatment is electrochemotherapy (ECT). ECT combines electropulsation of tumor cells (by local application of electric pulses) and administration of antineoplastic drugs such as cisplatin or bleomycin (either intravenous or intratumoral). Several clinical studies have demonstrated that ECT provides safe, efficient, and non-invasive locoregional treatment for chest wall breast cancer recurrence.

Thoracic Discitis as a Complication of Self-Expanding Metallic Stents in Esophageal Carcinoma

2009 ◽  
Vol 34 (S2) ◽  
pp. 300-302 ◽  
Author(s):  
A. S. McQueen ◽  
W. Eljabu ◽  
J. Latimer ◽  
P. P. J. Raju
Keyword(s):  
Esophageal Carcinoma ◽  
Metallic Stents

Fractures of self-expanding metallic stents in periampullary malignant biliary obstruction

2009 ◽  
Vol 50 (7) ◽  
pp. 730-737 ◽  
Author(s):  
I. C. Rasmussen ◽  
U. Dahlstrand ◽  
G. Sandblom ◽  
L. G. Eriksson ◽  
R. Nyman
Keyword(s):  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Metallic Stents ◽  
Biliary Duct ◽  
Stent Insertion ◽  
Stent Fracture ◽  
Metallic Stent ◽  
Stent Patency ◽  
Life Threatening ◽  
The Mean

Background: Self-expanding metallic stents are widely used for relieving biliary duct obstruction in patients with unresectable periampullary malignancies. However, only a few studies have assessed the occurrence of fractures in these stents. Purpose: To determine the prevalence and significance of stent fracture after placement of self-expanding metallic stents for periampullary malignant biliary obstruction. Material and Methods: Over a 5-year period, 48 patients underwent placement of self-expanding metallic stents for periampullary malignant biliary obstructions. Stents were introduced 2–6 weeks after a percutaneous transhepatic biliary decompression. The medical records and relevant images were reviewed for stent patency, stent fracture, type of stent, and stent-related complications. Results: Stent fracture was detected in four of the 48 patients (8%): in one patient at 1 month and in three patients between 10 and 21 months after stenting. All four fractures involved one type of nitinol stent used in 38 patients. In one of the patients, fracture was complicated by life-threatening gastrointestinal bleeding. The mean survival time for all patients was 251 days (standard deviation [SD]±275 days) and the mean overall patency time for all stents was 187 days (SD±205 days). Conclusion: Stent fracture occurs after placement of self-expanding nitinol stents for periampullary malignant biliary obstruction. The low reported incidence of this complication may be due to a lack of awareness of and difficulty in detecting stent fracture. Fracture should be considered as a possible contributing factor in recurrent biliary obstruction after self-expanding metallic stent insertion.

scholarly journals Coronaric Stent-Graft Deployment in the Treatment of Carotid Blowout

2011 ◽  
Vol 17 (4) ◽  
pp. 490-494 ◽  
Author(s):  
E. Pampana ◽  
R. Gandini ◽  
M. Stefanini ◽  
S. Fabiano ◽  
A. Chiaravalloti ◽  
...  
Keyword(s):  
Stent Graft ◽  
Clinical Results ◽  
Covered Stent ◽  
Endovascular Stent Graft ◽  
Carotid Blowout Syndrome ◽  
Rescue Treatment ◽  
Long Term Follow Up ◽  
Life Threatening

“Carotid blowout syndrome” is defined as a hemorrhage caused by rupture of the carotid artery and its branches, and may be a severe complication of rhinopharyngeal carcinoma. This study aimed to highlight the usefulness and versatility of endovascular stent-graft placement as a rescue treatment in life-threatening carotid blowout syndrome. We describe the unconventional use of a 6×5 mm balloon-expandable coronaric covered stent in a patient with a diagnosis of spinocellular rhinopharyngeal carcinoma, followed by carotid blowout syndrome. Although long-term follow-up is needed to assess the eventuality of bleeding recurrence, the immediate clinical results were satisfactory.

Is there a role for neoadjuvant radiation dose escalation in esophageal cancer? A meta-analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 102-102
Author(s):  
Laila Lobo ◽  
Danny Yakoub ◽  
Caroline Ripat ◽  
Rishika Sharma ◽  
Raphael Yechieli
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Radiation Dose ◽  
Esophageal Carcinoma ◽  
Meta Analysis ◽  
Survival Rates ◽  
Fistula Formation ◽  
Significant Difference ◽  
Patient Reported

102 Background: In treating esophageal cancer chemo-radiation is used in the definitive as well as neo-adjuvant setting. Optimal dosage of radiation for best outcome has been debated. The aim of this study is to evaluate clinical outcomes of lower radiation dosage compared to higher. Methods: Online search for studies comparing radiation dose from 1990 to present was performed. Primary outcome was overall-survival rates for up to 5 years. Secondary outcomes included post-treatment complications and treatment response. A cut point of 51 Gy and less was considered as lower dose and greater than 51 Gy was considered higher dose. Quality of included studies was evaluated by STROBE criteria. Relative Risk (RR) and 95% Confidence Intervals (CI) were calculated from pooled data. Results: The search strategy yielded 142 studies, 12 met our selection criteria and included 1876 patients receiving radiation for resectable esophageal carcinoma. Of these patients, 1057 received lower and 819 were treated with greater than 51 Gy. Median age was 63 and 64 years for lower and higher radiation dose respectively. Meta-analysis showed no statistically significant difference in survival and toxicities between the two groups. 1 year overall survival (RR = 0.97, 95% CI 0.84-1.13, p = 0.69), 2 year overall survival (RR = 1.29, 95% CI 0.76-2.19, p = 0.34), 3 year overall survival (RR = 1.18, 95% CI 0.83-1.68, p = 0.37), 4 year overall survival (RR = 1.37, 95% CI 0.64-2.94, p = 0.41), 5 year overall survival (RR = 1.11, 95% CI 0.72-1.69, p = 0.64), Esophagitis (RR = 0.76, 95% CI 0.39-1.50, p = 0.43), Dermatitis (RR = 0.98, 95% CI 0.12-7.94, p = 0.99), Fistula formation (RR = 0.72, 95% CI 0.32-1.60, p = 0.42), Hematologic complications (RR = 1.10, 95% CI 0.20-6.02, p = 0.91), Stricture formation (RR = 1.39, 95% CI 0.54-3.58, p = 0.5). Conclusions: Lower radiation dose appears to be as effective as higher dose in esophageal carcinoma with similar toxicity profile and survival rates. Larger prospective randomized trials, focusing on patient-reported quality-of-life are required to consolidate these results.

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