Self-expanding metallic stents (SEMS) are the treatment of choice for incurable obstructive malignant esophageal strictures. Although the placement of SEMS is usually performed with fluoroscopic control (FC), recently several authors have shown the feasibility of placing SEMS under endoscopic control alone (EC). However, studies comparing the two techniques are lacking. The objective of this study was to compare the feasibility and safety of SEMS insertion under fluoroscopic control and endoscopic control. The study was performed through the retrospective analysis of patients who underwent SEMS insertion for malignant dysphagia between January 2005 and January 2010. Data concerning early and late complications and survival were retrieved. Early complications were defined as pain, vomiting, bleeding, malposition/migration, perforation, and/or dysphagia occurring until 30 days of SEMS insertion; and late complications as tumor ingrowth and overgrowth, migration, hemorrhage, fistulae, food impaction, and/or esophagitis occurring after 30 days. We placed 126 SEMS of which 87% for esophageal stricture, 8% for esophagus-respiratory fistula, and 5% for extrinsic compression. The mean age of the patients was 62 years, and 93 were male. SEMS insertion was performed with FC in 66 patients and EC in 60. Early complications occurred in 34 patients (52%) in the FC group and 28 (47%) in the EC group (P=0.71), including: pain in 22 patients of the FC group and 15 of the EC group (P=0.31); vomiting in 15 of the FC group and nine of the EC group (P=0.27); malposition/migration in three of the FC group and four of the EC group (P=0.60); hemorrhage in one of the FC group and two of the EC group (P=0.27); and dysphagia in two of the FC group and three of the EC group (P=0.57). Late complications occurred in 20 patients (30%) in the FC group and 22 (37%) in the EC group (P=0.44), including: tumor in/overgrowth in 13 patients of the FC group and 10 of the EC group (P=0.66); prostheses migration in five of the FC group and eight of the EC group (P=0.28); hemorrhage in two of the FC group and two of the EC group (P=0.54); appearance of esophageal fistulae in seven of the FC group and four of the EC group (P=0.43); food impaction in nine of the FC group and eight of the EC group (P=0.96); esophagitis in 12 of the FC group and 15 of the EC group (P=0.35). Median survival was 107 days (95% confidence interval [CI]=6-369 days) with no difference between the two groups. There were no statistical significant differences in the incidence of complications and in survival between patients undergoing SEMS placement under fluoroscopic control or endoscopic control.
Moitos textos da literatura infantil, pola súa relación cos propósitos formativos, valoraron certos puntos de vista consistentes coas comunidades socio-culturales e os valores ideolóxicos dominantes. Isto non impide, non obstante, que algúns dos textos, máis alá da afirmación de certos mundos posibles, tamén conteñan unha considerable dimensión emancipadora. O artigo presenta e analiza seis álbumes narrativos infantís, publicados na Península Ibérica, algúns dos cales son traducións de obras estranxeiras importantes (La princesa Listilla, Babette Cole, 2004; El libro de los cerdos, Anthony Browne, 2006), onde se cuestionan os modos convencionais de representar o xénero, o que permite ao lector pensar outras formas de considerar a construción social e cultural de xénero, lonxe dunha concepción patriarcal e tradicional.
Primary aortoenteric fistula is a rare complication of aortic aneurysms. This cause of gastrointestinal bleeding poses significant diagnostic challenges due to its nonspecific presentation. We report a case of an 80-year-old man with right flank pain and rectal bleeding. The patient had been admitted 2 weeks before with the same symptoms. Upper and lower endoscopies were unremarkable, but abdominal computed tomography scan showed evidence of aortoduodenal fistula. An emergency laparotomy with aortic bypass and fistula closure was performed and the patient was able to recover in the following weeks. This case highlights the need for a high index of suspicion to avoid diagnostic delay that frequently has fatal results.
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