Stent implantation of the arterial duct in newborns with duct-dependent circulation

AIMS: Little is known about the medium term results after stenting of the arterial duct in neonates and infants with duct-dependent cyanotic congenital heart disease. We report the results of stent implantation of the arterial duct in 21 neonates and infants. The defects for which the arterial duct was stented included pulmonary atresia with intact ventricular septum, critical pulmonary stenosis, and more complex defects with associated reduced pulmonary blood flow. METHODS AND RESULTS: Palmaz stents were used and successfully implanted in all the 21 patients. There were no major complications during the stent implantation procedure although two hospital deaths occurred 2 and 14 days after stent implantation. Cardiac catheterization was repeated electively 3 to 6 months after stent implantation. Stent stenosis due to intimal proliferation was noted in 11/13 patients who underwent recatheterization. Stenosis of the inner stent lumen ranged from 25% to 100%, mean 74%. Re-dilatation of the stent was required in five patients who were awaiting corrective surgery. In babies with pulmonary atresia or critical pulmonary stenosis, who also underwent additional balloon dilatation of the pulmonary valve, spontaneous closure of the stented arterial duct was well tolerated and when it occurred, the right ventricular size had increased and the circulation was no longer duct-dependent. In patients who required subsequent surgical corrective treatment, stenting of the duct allowed the definite corrective operation to be performed as the first surgical procedure. During the follow-up period, ranging between 2 months and 2 years, mean 8.7 months increased growth of the pulmonary arteries was seen in all the patients. No distortion of the branch pulmonary arteries was seen. CONCLUSION: In patients with cyanotic congenital heart disease stenting of the arterial duct is an effective alternative to surgical aorto-pulmonary shunts.     

An unusual fatty acid pattern in Eranthis seed oil

Congenital stenosis and/or hypoplasia of the pulmonary veins(s) is a rare cardiac malformation, whose treatment is difficult and not well defined, so conditioning an extremely poor prognosis. In fact, balloon angioplasty and surgery proved to be ineffective during a mid-term follow-up, thus not significantly modifying the natural history of this cardiovascular malformation. Although heart-lung transplantation is thought by someone to be the sole reliable treatment for congenital stenosis of the pulmonary vein(s), a recently available therapeutic option, the endovascular "stent" implantation during cardiac catheterization prompted to hope for a better outlook for these patients. However, this procedure is far from being an easy approach, due to technical problems that cause a high rate of failure and major complications. We report on two cases of pulmonary vein stenosis successfully treated by endoluminal "stent" implantation during open heart surgery, and suggest, and suggest that this safe and effective approach might be an alternative therapeutic option in the definitive or palliative treatment of this congenital cardiovascular malformation.     

Predominance of the metastatic phenotype in hybrids formed by fusion of mouse and human melanoma clones

Endobronchial tuberculosis (EBTB) is a highly infectious disease that remains a diagnostic challenge in the developed countries. It also presents as a troublesome therapeutic problem due to its sequelae of cicatrical stenosis. Due to the worldwide decrease of tuberculosis, diagnosis of EBTB is frequently delayed until the onset of serious bronchial stenosis with resultant atelectasis and bronchiectasis. The exact pathogenesis of EBTB is not yet completely understood and the course of EBTB differs according to the type. The prognosis of actively caseating type and edematous-hyperemic type EBTB is grave, resulting fibrostenosis in two thirds of patients. Fibrostenotic type EBTB shows no change or worsening of stenosis. The prognosis is good for granular and non-specific bronchitic type EBTB; however, the prognosis of tumorous type is poor, frequently resulting in bronchial stenosis despite adequate treatment. Antituberculous chemotherapy is effective in controlling the infection, but does not prevent residual bronchostenosis. Early treatment with steroid therapy is effective in certain groups of EBTB. Balloon dilatation and stent insertion is an effective treatment of bronchial stenosis id obstruction of the stent by granulation tissue overgrowth can be prevented. Future research should focus on the pathogenesis of bronchial inflammatory reaction and resulting fibrosis to prevent bronchial stenosis at the early stage.     

An audit of anti-D sensitisation in Yorkshire

We present herein the case of a 59-year-old man in whom a Dumon stent, inserted as treatment for stenosis of the left main bronchus, caused a left bronchopericardial fistula. The patient initially presented with severe dyspnea caused by main bronchial stenosis of unknown origin for which a Dumon stent was inserted at a local hospital. The Dumon stent migrated to the endobronchus through the stenosis of the left main bronchus a few days later, and his dyspnea remained unresolved. He was subsequently referred to our department 6 months later, where a left pneumonectomy under supportive cardiopulmonary bypass through the femoral artery and vein was performed, and a postoperative pathological diagnosis of bronchial leiomyosarcoma was made. For this rare group of malignant tumors, early diagnosis permits complete surgical resection of the mass and offers the best prognosis. Excision of the tumor should be performed under cardiopulmonary bypass through the femoral vessels when a risk of sudden rupture of the pulmonary artery or vein exists for any reason.     

Study of characteristics of the antigen structure of different mycobacteria (epitope mapping) with monoclonal antibodies]

Although the use of a metallic stent in the treatment of benign tracheobronchial stenosis has been reported as a useful and safe technique, the incorporation of wire stents into the airway may be irreversible and is associated with problems. The authors' experience in a patient with incorrectly positioned metallic stent in the right main bronchus, which was successfully treated with bronchial sleeve resection, is presented.     

Stent implantation in solitary aneurysm of the common iliac artery

A 56-year-old man had intermittent claudication in the right leg for 11 months, gradually worsening of late. Digital subtraction angiography demonstrated an aneurysm, 8 x 2.5 cm, of the right common iliac artery and 70% stenosis of the right external iliac artery. As the patient refused full surgical intervention the aneurysm was treated by the insertion of two exactly adjoining wall stents (diameter 9 mm, length 7 cm), and the arterial stenosis was balloon-dilated. One month after stent implantation the aneurysm had thrombosed outside of the stent and the stent lumen was being perfused normally. 6 months later the local findings were identically. The patient remained symptom-free. --The case illustrates that management of circumscribed aneurysms by stent implantation could well be an alternative to surgical treatment, as long as the stent can prevent enlargement and rupture of the aneurysm.     

Determination of loratadine and pheniramine from human serum by gas chromatography-mass spectrometry

PURPOSE: To report initial experiences with stent implantation in the treatment of native and recurrent aortic coarctation in adults. METHODS: Two adult patients were diagnosed with aortic coarctation: in one, the native aorta was involved, and in the other, the stenosis involved a prior coarctation repair. Both patients were offered and selected angioplasty with possible stent implantation as an alternative to surgery. RESULTS: In the patient with recurrent narrowing, thrombolysis and balloon dilation preceded the successful deployment of three Palmaz stents along the grafted segment. In the case of native disease, one Palmaz stent was implanted primarily at the site of a critical, focal stenosis. No complications were encountered, and recovery was uneventful. Follow-up at 12 and 6 months, respectively, showed sustained clinical improvement with resolution of symptoms and excellent hemodynamic values. CONCLUSIONS: The positive outcome in these early cases supports further evaluation of the efficacy of adjunctive or primary stenting for treatment of native or recurrent aortic coarctation in adults.     

Nitinol alloy endotracheal stent for treatment of tracheal stenosis

OBJECTIVE: To treat inoperable tracheal stenosis by using nitinol endotracheal stent and to solve some problems facing endotracheal stenting with other kinds of stents. METHODS: The stent was made of nitinol wire. It can be deformed to smaller size in iced water. With a self-made introducer, the stent was placed in the location of stenosis. After hot water was injected into the introducer, the stent resumed its original form and anchored there itself. RESULTS: Altogether, 5 patients with severe tracheal stenosis received this treatment. Dyspnea was relieved immediately after implantation of stents in all patients. Long-term follow-up also showed satisfactory results. CONCLUSION: Nitinol stent has some remarkable advantages as compared with other tracheal stents. It can be used as a new endoprosthesis in treating narrowed trachea.     

The oxidative metabolism of catecholamines in the brain: a review

The EBI (BARD-XT, C.R. Bard, Murray Hill, NJ) stent is a new radiopaque balloon expandable coronary stent with high resistance to external radial forces. It does not shorten significantly with expansion and allows stent implantation in bifurcation lesions. A total of 28 EBI stents were implanted in 23 lesions in 21 patients. Indications for stent implantation were acute closure in 1, threatened closure in 15, and electively in 7 lesions. In 2 cases, the lesion involved a bifurcation where a stent was implanted in both vessels. All patients received aspirin and ticlopidine. No anticoagulant therapy was given. The stenting procedure was successful in 22 of 23 lesions. No complications occurred with the exception of 1 patient with a thrombotic reocclusion within 1 hr after stent implantation and 1 patient with a temporary occlusion of a side branch. The mean minimal luminal diameter (MLD) increased from 0.74+/-0.46 mm before balloon dilatation to 1.27+/-0.62 mm before stent implantation and 2.32+/-0.57 mm after stent implantation. Percent stenosis decreased from 71+/-19% before angioplasty to 46+/-25% after angioplasty to 5+/-8% after stent implantation. MLD at the time of follow-up angiography after 4 months was 1.98+/-0.77 mm and percent stenosis was 26+/-21%. Restenosis of more than 50% occurred in 2 lesions. In these lesions, a second percutaneous transluminal coronary angioplasty was performed. Advantages of this stent are its flexibility together with an acceptable radial strength as well as enabling radiopacity without obscuring the arterial lumen. Stenting of bifurcation lesions is possible.     

Use of balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation

STUDY OBJECTIVES: Bronchial stenosis (BS) and bronchomalacia (BM) are often associated with lung allograft rejection or infection in lung transplant (LT) recipients. We reviewed our experience using balloon-expandable metallic (Palmaz) stents in the management of BS and BM in LT. DESIGN: Retrospective review of cases. PATIENTS: LT recipients with bronchoscopic and spirometric evidence of BS and BM. INTERVENTIONS: Serial balloon dilation was performed for BS. Stent placement was done for refractory or recurrent BS, or persistent focal BM. RESULTS: Twelve of 129 LT bronchial anastomoses at risk (9.3%) had complications, which included 11 BS and 5 BM. Four BS were accompanied by BM either concurrently or subsequently. The only isolated BM was associated with acute rejection and resolved after appropriate medical therapy. Balloon dilations alone were successful in relieving BS in three cases. Seven patients received a total of 11 stents. Stents were placed under conscious sedation using a flexible bronchoscope. Five of the seven patients had spirometric improvements after stent placements. One patient had no spirometric improvement, and another died before a follow-up study was done. There were no complications during stent placements. However, complications after stent placements included partial dehiscence of the stent from the bronchial wall, stent migration, partial obstruction of a segmental bronchial orifice by a stent in the main bronchus, and longitudinal stent collapse. One stent was successfully removed using a flexible bronchoscope in the endoscopy suite, and two others were removed by rigid bronchoscopy in the operating room. CONCLUSIONS: Endobronchial placement of the Palmaz stent in LT recipients is relatively easy, and it can be removed if needed. However, because there are significant potential complications, the future use of this stent as an airway prosthesis in LT remains unclear.     

Detection of telomerase activity in oral lesions

We present a rare complication of pericardiectomy and the effective management thereof. A 67-year-old female with dyspnea and upper abdominal pain was received at our department upon referral. Chest roentgenogram and cardiac catheterization preceded a diagnosis of constrictive pericarditis. Pericardiectomy was performed subordinate to median sternotomy and left anterolateral thoracotomy. Extubation was carried out on day 2 but reintubation was necessitated on the same day as a result of progressive dyspnea. Chest roentgenogram revealed an atelectasis of the left lung. Fiberoptic bronchoscopy showed left main bronchial stenosis resulting from a pulsating external structure. A postoperative computed tomogram substantiated the stenotic left main bronchus between the dilated left pulmonary artery and the thoracic descending aorta. An expandable metallic stent for the treatment of this complication was selected over other invasive procedures. Two years of follow-up reveal no complications. Accordingly, an expandable metallic stent has demonstrated its effectiveness not only on bronchial stenosis due to malignancy or tuberculosis but on benign cases such as this as well.     

Unprotected left main angioplasty: a case report

Left main angioplasty is considered a very high-risk procedure and consequently, surgical treatment remains the first choice for left main critical disease. Recently, the advent of new devices such as directional atherectomy, rotablator atherectomy and stent implantation have modified this point of view. In fact, in selected groups of patients for whom CABG is not suitable, left main percutaneous angioplasty can be performed with stent implantation, yielding good final results with a residual stenosis less than 20-30% and a long-term survival comparable to surgery. In conclusion, in some selected cases left main angioplasty, also if unprotected, can be performed safely with satisfactory results.     

Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy

The side-effects of radiation therapy on the bronchial tree or on the mediastinum are seldom reported. In this setting, we report a case of sclerosing mediastinitis with bronchial stenosis discovered 1 yr after external radiotherapy for lung cancer. The patient was treated with a Dumont stent and has so far had an uneventful further course for up to 42 months. Bronchial stenosis related to mediastinal fibrosis after radiotherapy has not been reported previously.     

A heparin-coated circuit maintains platelet aggregability in response to shear stress in an in vitro model of cardiopulmonary bypass

PURPOSE: To report the authors' experience in treatment of ruptures complicating percutaneous transluminal angioplasty (PTA) of hemodialysis access with implantation of a Wallstent. MATERIALS AND METHODS: Between January 1, 1990, and October 1, 1995, the authors performed 2,414 PTAs of angioaccesses. A severe rupture occurred in 40 (1.7%) of these procedures and was treated by means of stent placement. Wallstents were implanted in 37 of these ruptures. The angioaccesses comprised 22 grafts and 15 fistulas. The indications for stent placement were four isolated pseudoaneurysms and 33 cases of bleeding: 15 major leaks, five moderate leaks that persisted despite prolonged inflation at low pressure, seven leaks associated with greater than 50% residual stenosis, four leaks associated with pseudoaneurysm, and two leaks associated with both greater than 50% residual stenosis and pseudoaneurysm. Seventeen ruptures were located on a vein, 19 on the venous anastomosis of a graft, and one on a graft itself. RESULTS: Stent placement stopped the bleeding immediately in 28 cases and after prolonged inflation within the stent in four cases. Residual bleeding required implantation of a covered Cragg stent within the Wallstent in one case. A pseudoaneurysm was still visible at the end of the intervention in 11 cases. Two complications occurred; one hematoma was drained surgically and one access occluded on day 2. Follow-up angiography showed a small pseudoaneurysm in only one patient with impaired platelet function. The primary and secondary patency of the angioaccesses were 48% and 86% at 1 year, respectively. CONCLUSION: Wallstent implantation is very effective for both immediate and long-term treatment of rupture of angioaccess during PTA.     

Isolation and characterization of an endogenous inhibitor of phospholipase A2 from Indian cobra (Naja naja naja) venom

PURPOSE: To evaluate the efficacy of stent deployment in the treatment of recurrent stenosis of transplant renal arteries (TRAs). PATIENTS AND METHODS: This retrospective study includes six consecutive patients who underwent a mean of 3.66 previous treatments of TRA stenosis per patient before stent implantation (20 angioplasties and two surgical procedures). The endoprostheses were a Wallstent in four patients and a Palmaz stent in two patients. Clinical, laboratory, and duplex scanning follow-up was performed every 6 months after stent placement in all patients. RESULTS: The procedure was a technical success in all patients. At 6 months, mean systolic blood pressure decreased from 179 to 152 mm Hg (P = .018) and mean diastolic blood pressure decreased from 102 to 90 mm Hg (P = .09). Mean serum creatinine level dropped from 269 to 182 mmol/L (P = .03) and the number of antihypertensive drugs per patient decreased from 2.5 to 1.6. At a mean follow-up of 34 months (range, 7-60 months), all TRAs were patent, with a stenosis less than 50% without clinical consequences in one patient. No secondary procedure was necessary. CONCLUSION: Stent placement seems to be an effective treatment of TRA recurrent stenosis. Midterm follow-up shows satisfactory clinical results and TRA patency rates. This technique might be considered as a valuable therapeutic option for the treatment of TRA recurrent stenosis.     

Trapezoid dislocation with a Galeazzi fracture

Significant airway stenosis occurs in 7% to 14% of lung transplant recipients. The use of permanent, nonadjustable, wire mesh stents can be of concern in the transplant recipient with nonmalignant stricture. We report the replacement and repositioning of an expandable wire mesh stent in a double lung transplantation with distal bronchial stenosis.     

Scimitar syndrome in infancy

OBJECTIVES: The objectives of this study were to determine the anatomic and physiological factors most responsible for the severe symptoms and poor prognosis of infants with scimitar syndrome. BACKGROUND: Whereas the diagnosis of scimitar syndrome is often made incidentally in older children and adults who undergo chest radiography for diverse reasons, infants in whom the diagnosis is made typically present with severe symptoms and have a poor prognosis. METHODS: The clinical, catheterization and imaging data of 13 consecutive infants with scimitar syndrome who underwent cardiac catheterization in the 1st 6 months of life were reviewed, with emphasis on the pulmonary artery pressure, pulmonary and cardiovascular anatomy, therapeutic interventions and outcome. RESULTS: Twelve of the 13 infants had pulmonary hypertension at the time of diagnosis. Six patients died despite specific treatment. Eleven of 13 infants had associated cardiac malformations and 9 had large systemic arterial collateral channels to the right lung. Seven patients had anomalies involving the left side of the heart, especially varying degrees of hypoplasia of the left heart or aorta, and six of these patients died. Ten patients underwent surgical or transcatheter therapy in the 1st year of life. Systemic arteries to the right lung were ligated in three patients and occluded by transcatheter embolization in four. Balloon angioplasty was carried out in two patients, one with stenosis of the left-sided pulmonary veins and one with stenosis of the anomalous right pulmonary vein. The latter had placement of a balloon-expandable stent. In both patients, pulmonary vein stenosis progressed. Six patients had surgical repair of associated cardiovascular anomalies, and two required repair of extracardiac congenital anomalies. Occlusion of the anomalous systemic arteries was generally associated with clinical improvement, but congestive heart failure and pulmonary hypertension recurred in those patients with associated cardiovascular anomalies, whose condition subsequently responded after correction of the shunt lesions. CONCLUSIONS: The severe symptoms and pulmonary hypertension found in infants with scimitar syndrome have many causes. Anomalous systemic arterial supply, pulmonary vein stenosis and associated cardiovascular anomalies play a significant role, and the ultimate outcome of individual infants depends on the feasibility of treating these anomalies in early infancy.     

Endoscopic palliative treatment of tumors of the gastrointestinal tract

Patients with nonresectable gastrointestinal tumors have a life expectancy of a few months only. Effective palliative treatment has to ensure a good quality of life with minimal morbidity and mortality. Esophageal carcinoma: Endoscopic intubation or stent implantation guarantee a prompt improvement of dysphagia with minimal morbidity and mortality in esophageal carcinoma. Only in cervical or noncircumferential stenosis laser therapy is preferable. Obstructive jaundice: Metal stents offer the best quality of life after palliative treatment of malignant obstructive jaundice. However, in patients with bad general conditions and a short life expectancy a pigtail catheter is less expensive. Colorectal cancer: Laser therapy and cryosurgery offer uncomplicated nonsurgical therapy in rectal carcinoma. Stents in the colorectum have a high complication rate. Endoscopic palliative treatment of gastrointestinal tumors can be performed with minimal morbidity and mortality. However, it is essential that a surgeon is involved in the decisionmaking between endoscopic or operative treatment.     

Stent implantation as a palliative therapeutic measure in stenosing tumors of central airways

PURPOSE: Stent implantation was used to treat patient with malignant tracheobronchial obstructions to determine the effectiveness in producing symptomatic palliation. METHODS: 18 patients (15 men and three women; median age 57 years) with malignant tracheobronchial stenosis were treated by application of metal stents (15 Palmaz-, 10 Gianturco-, 4 Wallstents). The indication for stent implantation was given in 13 patients by clinically significant dyspnea, besides in 5 patients by therapy resistant postobstructive pneumonia. RESULTS: In 17 patients correct positioning of the stents was achieved and the symptoms completely disappeared until tumor related death. Median survival was 137 days (min. 10 days to max. 322 days). In one patient symptoms recurred three months after stent implantation. CONCLUSION: The application of metal stents in patient with malignant tracheobronchial obstruction appears to be a useful palliation procedure. The treatment was well tolerated and very effective.     

Assessment of cold stress in outdoor work

This study was performed to determine the efficacy of balloon-expandable stents in the treatment of branch pulmonary artery-stenoses and conduit stenosis in children. A total of eight stainless steel stents were implanted in seven patients. Three patients had tetralogy of Fallot with pulmonary artery stenosis following total correction, one patient had conduit stenosis following correction of transposition of the great arteries, one patient had intra-cardiac conduit stenosis after septation for single left ventricle, and two patients had pulmonary artery stenosis after Fontan operation. Six stents were placed in the branch pulmonary arteries, one in the extracardiac conduit, and one in the intracardiac conduit. The mean age at implantation was 13 +/- 3 years and the mean weight 37 +/- 12 kg. Follow-up time ranged from 0.3-2 years. The diameter of pulmonary arteries with stenoses increased from 5.6 +/- 2.2 mm to 10.6 +/- 1.8 mm (n = 7). The systolic pressure gradient decreased from 56 +/- 26 mmHg to 22 +/- 16 mmHg (n = 5). No embolization or thrombotic event has been noted. One stent placed in the intracardiac conduit was compressed and fractured. These data indicate that balloon-expandable stents are useful in the treatment of pulmonary artery branch stenoses and extracardiac conduit stenosis in children. The use of stents for intracardiac stenosis may result in stent fracture.