Expandable Metallic Endoprostheses for Biliary Obstruction

Expandable metal stents (20 Gianturco Z-stents and 1 Strecker stent deployed through 8.5 F sheaths) were used with initial success for palliating bile duct obstruction in 10 patients, 8 with malignant and 2 with benign strictures. Short-term failure occurred in one patient after 2 weeks, one died of unrelated causes after 10 days, and one remained jaundiced due to fulminant liver metastases. In the remaining 7 patients the obstruction was markedly palliated, with normalization of the serum bilirubin. Four have died without recurrent bile duct obstruction after a mean of 5.9 months, the 2 with benign strictures are well after 4 and 7 months, and one patient is presently palliated with a plastic endoprosthesis following reocclusion after 4 months. Expandable stents were easier to insert than conventional percutaneous endoprostheses of plastic polymers, and had longer patency in several patients, but reocclusion by tumor growth remains a constant threat in malignant disease. Metallic stents may be the therapy of choice in recurrent benign strictures, although the definitive conclusion needs longer observation and larger materials.

Percutaneous Transhepatic External Biliary Drainage Utilizing a Pig Tail Balloon Catheter

A 2.3-mm soft pig tail balloon catheter was developed to be used for percutaneous transhepatic biliary drainage. A small balloon (OD 10 mm) secures an optimal internal fixation and side holes behind the balloon secure drainage of the cannulated bile duct peripheral to the balloon. Successful transhepatic biliary drainage with the pig tail balloon catheter was achieved in 11 of 12 patients for a period of 3 to 67 days (median 6 days). In one patient the catheter clogged after 55 days of drainage. No case of catheter dislodgement or other complications related to the external drainage was seen.

Strict follow-up programme including CT and ¹⁸F-FDG-PET after curative surgery for colorectal cancer

AIM

The risk of local recurrence following curative surgery for colorectal cancer (CRC) is up to 50%. A rigorous follow-up program may increase survival. Guidelines on suitable methods for scheduled follow up examinations are needed. This study evaluates a strict follow-up program including carcinogenic embryonic antigen (CEA), chest X-ray, abdominal ultrasound (US), computed tomography (CT) and (18)F-FDG positron emission tomography (FDG-PET).

METHOD

A cohort of 132 patients, treated by surgery with curative intent for CRC, was included. Patients were followed prospectively with scheduled controls at 3, 6, 12 and 24 months after curative surgery. CEA, chest X-ray, US, CT and FDG-PET supplemented by clinical examination. The end-point was recurrence. Sensitivity and specificity was estimated 2 years after surgery.

RESULTS

Of the 132 patients included in the study, 25 experienced recurrence, detected at scheduled controls (n = 18) and at intervals between them (n = 7). The results of CT and FDG-PET were correlated with recurrence. CT combined with FDG-PET had the highest specificity and sensitivity.

CONCLUSION

A total of 72% of recurrences were detected at scheduled controls. The findings supported a strict follow-up program following curative surgery for colorectal cancer. FDG-PET combined with CT should be included in control programs.

Percutaneous transhepatic external biliary drainage utilizing a pig tail balloon catheter

A 2.3-mm soft pig tail balloon catheter was developed to be used for percutaneous transhepatic biliary drainage. A small balloon (OD 10 mm) secures an optimal internal fixation and side holes behind the balloon secure drainage of the cannulated bile duct peripheral to the balloon. Successful transhepatic biliary drainage with the pig tail balloon catheter was achieved in 11 of 12 patients for a period of 3 to 67 days (median 6 days). In one patient the catheter clogged after 55 days of drainage. No case of catheter dislodgement or other complications related to the external drainage was seen.

Expandable metallic endoprostheses for biliary obstruction

Expandable metal stents (20 Gianturco Z-stents and 1 Strecker stent deployed through 8.5 F sheaths) were used with initial success for palliating bile duct obstruction in 10 patients, 8 with malignant and 2 with benign strictures. Short-term failure occurred in one patient after 2 weeks, one died of unrelated causes after 10 days, and one remained jaundiced due to fulminant liver metastases. In the remaining 7 patients the obstruction was markedly palliated, with normalization of the serum bilirubin. Four have died without recurrent bile duct obstruction after a mean of 5.9 months, the 2 with benign strictures are well after 4 and 7 months, and one patient is presently palliated with a plastic endoprosthesis following reocclusion after 4 months. Expandable stents were easier to insert than conventional percutaneous endoprostheses of plastic polymers, and had longer patency in several patients, but reocclusion by tumor growth remains a constant threat in malignant disease. Metallic stents may be the therapy of choice in recurrent benign strictures, although the definitive conclusion needs longer observation and larger materials.

Focal intracerebral oedema in hypertensive encephalopathy visualized by computerized tomographic scan

A previously healthy man was admitted due to a severe rise in the arterial blood pressure. The patient was found confused and drowsy, but the neurological investigation was otherwise normal. A computerized tomographic scan of cerebrum showed widespread areas of diminished density in the brain. After normalization of the arterial blood pressure, a new computerized tomographic scan did not show any pathological enhancement. The total regression of signs and symptoms after the normalization of the blood pressure support the assumption that a severe increase in blood pressure leads to formation of focal cerebral oedema.

Radiologic evaluation of the continent (S-pouch) ileal reservoir with anal anastomosis

A radiologic investigation was performed in 26 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. The reservoir and its efferent leg was best demonstrated by contrast enema. The size and position of the reservoir and the efferent leg was demonstrated, and stenoses, abscesses and fistulae could be identified. Examination of the small bowel with a contrast medium showed slight dilatation of the ileum orally to the reservoir in all instances and one patient had a stenosis at the junction of the afferent leg of the reservoir. Erect and supine projections of the abdomen showed gas in the intestine and fluid levels in the reservoir. These radiographic findings should not be confused with ileus or pelvic abscess. Radiology was of great value in disclosing postoperative complications.

Follow-up study after colorectal polypectomy. The predictive value of a negative double-contrast barium enema

In this study the predictive value of a negative double-contrast barium enema for colonic polyps has been calculated as the ratio of the number of true negative radiologic examinations to the total number of negative radiologic examinations. The total number of negative double-contrast barium enemas for polyps of the colon was 357 in 228 consecutive patients with previous or suspected neoplastic colonic polyps examined in the period 1977-84. The predictive value of a negative double-contrast barium enema for all colonic polyps regardless of size was 87% (95% confidence interval, 84-91%). The corresponding predictive value of a negative result for polyps larger than 10 mm in diameter was 98% (95% confidence interval, 97-100%). Polyps that had not been detected by radiography were removed by colonoscopy, and 85% of them were available for histological examination. No cancers were found. The polyps were primarily neoplastic, but metaplastic and juvenile polyps were also ascertained.