Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study

AIM

To evaluate retrospectively the incidence and predictors of massive bleeding after stent placement for malignant oesophageal stricture/fistulae.

MATERIALS AND METHODS

This retrospective study comprised 519 patients with malignant oesophageal stricture/fistulae that were successfully treated with stent placement at three hospitals. The patients were divided into two groups based on the occurrence of massive bleeding. Univariate and multivariate analysis was performed to evaluate predictive factors of massive bleeding.

RESULTS

Massive bleeding occurred in 54 of 519 patients 1-37 days following stent placement. All of the patients who developed massive bleeding died within 24 hours of the event. Univariate analysis showed massive bleeding was associated with the presence of a concomitant tracheal stent (p<0.001), the existence of concomitant oesophageal fistulae (p<0.001), and prior radiotherapy (p<0.001). Multivariate analysis exhibited that concomitant tracheal stent insertion (odds ratio [OR], 23.134; 95% confidence interval [CI], 9.523-56.199; p<0.001), the presence of oesophageal fistulae (OR, 3.724; 95% CI, 1.677-8.269; p=0.001), and prior radiotherapy (OR, 13.310; 95% CI, 5.464-32.421; p<0.001) were predictors of massive bleeding following stenting.

CONCLUSIONS

The presence of oesophageal fistulae, prior radiotherapy, and concomitant tracheal stent are important factors contributing to bleeding after stenting.

Effect of intravenous infusions of 12-O-tetradecanoylphorbol-13-acetate (TPA) in patients with myelocytic leukemia: preliminary studies on therapeutic efficacy and toxicity

Studies by several investigators have shown that 12-0-tetradecanoylphorbol-13-acetate (TPA) is an extraordinarily potent stimulator of differentiation of cultured human promyelocytic leukemia cells in vitro. In the present study, TPA was administered to humans by i.v. infusion without irreversible toxicity, and it was shown to have pharmacological activity for the treatment of myelocytic leukemia in patients refractory to cytosine arabinoside (Ara C), retinoic acid, and other antileukemic drugs. Marked decreases in bone marrow myeloblasts as well as temporary remission of disease symptoms were observed when TPA was administered alone or in combination with vitamin D3 and Ara C. Additional studies with TPA after the determination of optimum dosing regimens are needed to determine whether long-lasting or permanent remissions of myelocytic leukemia can be achieved. Transient and reversible side effects were observed after a 1-mg i.v. dose of TPA, but these adverse effects became less intense or disappeared when a lower dose of TPA was used. The results of this study indicate a therapeutic effect of TPA in patients with myelocytic leukemia.

[Air plethysmography in the diagnosis of primary venous insufficiency of lower extremities]

Through the assessment 101 limbs of 77 subjects by air plethysmography (AP), we studied the method of AP test and the values of various indices in diagnosis of primary venous insufficiency (PVI). Venous filling index (VFI) was found valuable to quantitate the venous reflux with its value beyond the threshold of 5 ml/sec. It has a potential value to assess the effect of operations on PVI, such as valvuloplasty aiming to abolish venous reflux. Ejection fraction (EF) was found to be abnormal with its value less than 40%. It may be used to evaluate the function of calf pump quantitatively, predict the ulcer formation, and help make a decision of surgery timely. The comprehensive analysis of VFI, EF, RVF (residual volume fraction) and AVP (ambulatory venous pressure) indicated that there seems to be different types of PVI: type 1, low ejection (low EF) high venous reflux (high VFI); type 2, high ejection low venous reflux; type 3, low ejection low venous reflux. This new classification may impose some on the selection of adequate therapies, which will be further investigated.

[Superficial femoral vein valvuloplasty under direct angioscopic vision]

Superficial femoral vein valvuloplasty (SFV) under direct angioscopic vision without venotomy was designed and performed in 18 patients (20 limbs), suffering from primary SFV valve incompetence and the primary popliteal vein valve insufficiency. The indication of the operation is that the valves developed completely inborn, but with the effects of postnatal pathogenic factors, the leaflets prolapsed and became redundant, irregular diastema between leaflets emerged and the valve-ring dilated. The operation has several advantages: (1) Angioscopy confirms primary venous valve incompetence. (2) The technique precludes venotomy and valve exposure, reducing the rate of postoperative venous thrombosis. (3) The operation eliminates the blindness of kistner's external surgical technique, overcoming its empiricism. The initial clinic use of the technique has shown that it is of excellent short-term effect without complications.