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Author(s): Aga Jimu [1]; Xiuli Liu [1]; Yingqi Fan [1]; Pengfei Yu (corresponding author) [1] Bronchopleural fistula (BPF) is characterized as an aberrant connection between the bronchial tree and the [...], Bronchopleural fistula (BPF) is a rare yet severe complication following lobectomy, with no standardized treatment protocol established. We present a case of a 65-year-old male with chronic obstructive pulmonary disease who developed multiple BPFs postresection of the right lower lobe due to lung cancer and with tumor recurrence and metastasis. We employed a comprehensive management strategy comprising rigorous infection control, meticulous chest drainage, antitumor treatment, and targeted deployment of bronchial stents. This approach not only resolved the BPFs but also achieved a complete response of the lung cancer, extending progression-free survival to over 3 years. Keywords: Bronchopleural fistula, endoscopic intervention, lung cancer, tracheal bronchial stents

Multimodalities endovascular treatment of multiple aneurysms of the anterior circulation. Case report Introducción Los aneurismas cerebrales constituyen una enfermedad grave, a pesar de todo el conocimiento médico corriente respecto a [...], Aneurismas cerebrales son una enfermedad grave, a pesar del alto grado de conocimiento respecto su fisiopatología y patogenia. La letalidad de ruptura de un aneurisma cerebral es todavía alrededor de 50%, allá de altas tasas de morbilidad. El tratamiento endovascular ha evolucionado en las últimas décadas para mejorar los resultados. Se presenta el caso de un paciente con síntomas neurológicos graves secundarios a la hemorragia subaracnoidea, cuya investigación mostró múltiples aneurismas. Varios dispositivos fueron utilizados en modalidades terapéuticas endovasculares consecutivas, incluyendo la embolización con remodelación, colocación de stents y desviador de flujo, con buen resultado clínico y angiográfico. Palabras clave: Aneurisma intracraneal, hemorragia subaracnoidea aneurismática, embolización terapéutica, procedimientos endovasculares. Cerebral aneurysms are a serious illness, despite the high degree of knowledge about its pathophysiology and pathogenesis. The lethality of cerebral aneurysm's rupture is still about 50% beyond high morbidity. Endovascular treatment has evolved in recent decades to improve outcomes. It is reported the case of a patient with severe neurological symptoms secondary to subarachnoid hemorrhage, whose examination showed multiple aneurysms. Several devices were used on consecutive endovascular therapeutic modalities, including remodeling embolization, stenting and flow diverter, with good clinical and angiographic outcome. Key words: Intracranial aneurysm, aneurysmal subarachnoid hemorrhage, therapeutic embolization, endovascular procedures.

Introduction Renal artery stenosis (RAS) is an important cause of hypertension in adults (5%) [1] and children (10%) [2]. Atherosclerosis is the predominant etiology in adult patients [3]. Conversely, children [...], Background Renal artery stenosis (RAS) accounts for 10% of cases of systemic hypertension in children. Initial management involves anti-hypertensive therapy. Percutaneous interventions are documented for the treatment of RAS in the adult population. In children, case reports suggest benefit. Methods This is a retrospective analysis of consecutive patients referred for catheterization for RAS between 2002 and 2010 at a single institution. Recorded variables included: age, weight, systemic blood pressure, minimal luminal diameter, interventional devices, antihypertensive medications, contrast volume, and complications. Results Twelve patients (median age 8.2, IQR 6-12.4 years); median weight 42.8 kg, IQR: 25-47.4 kg) were referred for renal artery catheterization and underwent percutaneous intervention. Overall, minimal luminal diameter (MLD) increased by 1.2 ± 0.9 mm for all patients (p < 0.05) and by 1.3 ± 0.9 mm for post-renal transplant patients (p < 0.05). Only stent angioplasty patients demonstrated significant improved blood pressure (p < 0.05). One patient had stent thrombosis requiring re-intervention with repeat balloon angioplasty. Conclusions This retrospective analysis suggests that percutaneous intervention might play a role in the management of RAS, with an improvement in MLD in children with RAS. Transcatheter intervention is technically feasible with low morbidity. A prospective, longitudinal study is warranted to compare standard medical therapy with percutaneous interventions. Keywords Renal artery stenosis * Percutaneous intervention ? Balloon angioplasty * Stent angioplasty * Minimal luminal diameter * Children

Endoscopic deployment of self-expanding metal stents (SEMS) enables temporary relief of acute large bowel obstructions. This procedure provides an opportunity to cleanse the bowel and perform a semi-elective 1-stage colonic [...], Background: Self-expandable metal stents (SEMS) can provide temporary relief of acute large bowel obstructions. Placement of SEMS creates the opportunity for semi-elective 1-stage surgical resections, use of possible adjuvant therapy or palliative relief of malignant obstructions. Our aim was to assess the likelihood of success and possible complication rates of SEMS insertion in a community hospital setting in patients presenting with large bowel obstructions. Methods: We conducted a retrospective chart review at a single community-based hospital. This review addressed the technical success in deployment of the SEMS, clinical success defined by relief of the obstruction, procedure-related complications, surgical interventions and completion of adjuvant therapy for patients with large bowel obstructions. Results: In a 34-month period, 16 patients underwent 16 SEMS procedures. The average age of patients was 69.4 years and 7 (44%) were women. Thirteen patients had intrinsic colorectal cancers, 1 had an extracolonic lesion (ovarian cancer) and 2 had strictures due to diverticular disease. Technical success occurred in all 16 patients, but only 15 (94%) had clinical success. No procedure-related deaths (defined as death within 7 days) occurred. Palliative stenting occurred in 5 patients (31%). Eleven patients (69%) eventually had surgery. Stenting allowed a window for neoadjuvant therapy in 4 patients. Ten of 11 patients (91%) had a 1-stage procedure. One patient had a cecal perforation presenting 2 days after SEMS. This patient received a defunctioning ileostomy. Conclusion: In appropriate patients with large bowel obstructions, SEMS procedures can be safely and effectively performed in a community-based setting. Contexte : Les prothcses metalliques auto-expansibles (PMAE) permettent une correction temporaire des occlusions aigues du colon. La pose d&apos;une PMAE offre en effet la possibilite de proceder a une resection chirurgicale semi-urgente de stade 1, d&apos;administrer un traitement adjuvant ou de soulager a titre palliatif les obstructions d&apos;origine neoplasique. Nous avons voulu evaluer les probabilites de succcs et les taux de complications possibles associes aux PMAE dans un contexte hospitalier communautaire chez des patients souffrant d&apos;une importante occlusion intestinale. Methodes : Nous avons procede a une analyse retrospective des dossiers d&apos;un seul hopital communautaire. Cette analyse tenait compte de la reussite technique des PMAE, de la reussite clinique definie par la desobstruction, des complications de l&apos;intervention, du recours a la chirurgie et de l&apos;administration de traitements adjuvants chez des patients souffrant d&apos;une occlusion du colon. Resultats : Sur une periode de 34 mois, 16 patients ont recu une PMAE. Ils etaient ages en moyenne de 69,4 ans et 7 (44%) etaient des femmes. Treize patients avaient un cancer colorectal intrinscque; il y avait 1 cas de lesion extracolique (cancer de l&apos;ovaire) et 2 patients presentaient des strictures attribuables a une maladie diverticu-laire. On a enregistre une reussite technique chez les 16 patients, mais 15 seulement (94%) ont obtenu une reussite clinique. On n&apos;a deplore aucun deccs en lien direct avec l&apos;intervention (defini par sa survenue dans les 7 jours suivants). Chez 5 patients (31 %), on a pose une prothcse a des fins palliatives. Onze patients (69%) ont eventuellement subi une chirurgie. La prothcse a permis l&apos;administration d&apos;un traitement neoadjuvant chez 4 patients. Dix patients sur 11 (91%) ont subi une intervention de stade 1. On a deplore une perforation du coecum chez un patient 2 jours aprcs la pose de la PMAE; on a procede a une ileostomie temporaire chez ce patient. Conclusion : Chez certains patients souffrant d&apos;une obstruction du colon, on peut proceder sans danger et efficacement a la pose de PMAE dans un contexte hospitalier communautaire.

Introduction If surgical treatment for benign or malignant tumors may be difficult in a patient with tracheobronchial stenosis, stent placement can prevent respiratory failure [1-9]. In addition, with advances in [...], We have provided general anesthesia for a 53-year-old man scheduled to undergo lymph node removal for right mediastinal lymph node metastases caused by esophageal cancer. One year prior, acute respiratory failure occurred because of stenosis of the carinal bifurcation resulting from advanced esophageal cancer with tracheal invasion. The patient underwent placement of tracheobronchial stents (Spiral Z Stent) in two locations (left main bronchus and trachea/right main bronchus), followed by radiotherapy and chemotherapy. In the present case, after an 8.5-mm-ID tracheal tube was placed under bronchoscopic guidance, a 7.0 Fr. bronchial blocker (Arndt Endobronchial Blocker; Cook, Bloomington, IN, USA) was carefully inserted into the stent in the right main bronchus. Next, 3 ml air was injected into the blocker cuff, and left-sided one-lung ventilation was performed. After surgery was completed, the bronchial blocker was removed under bronchoscopic guidance. We confirmed there was no tracheobronchial injury nor stent displacement or deformation, then removed the tracheal tube. Even in patients with tracheobronchial stent placement, one-lung ventilation can be safely and reliably performed by selecting an appropriate bronchial blocker, along with careful insertion into the stent and frequent checking of the blocker position. Keywords Tracheobronchial stenting * One-lung ventilation * General anesthesia * Esophageal cancer

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2009.00361.x Byline: Marcel Brus-Ramer (1), Robert M. Starke (1), Ricardo J. Komotar (1), Philip M. Meyers (1) Keywords: Hyperperfusion; stenting; stenosis; intracranial; arteriosclerosis Abstract: ABSTRACT BACKGROUND AND PURPOSE Hyperperfusion is a rare but serious complication following cerebrovascular angioplasty and stent placement. Radiographically identifying hyperperfusion before the development of severe sequelae is difficult, as few diagnostic criteria have been established. METHODS A 50-year-old woman, initially presenting with 6 weeks of right-sided hemiparesis and dysarthria, was treated for severe stenosis of the left internal carotid and middle cerebral arteries with intracranial angioplasty and placement of a balloon mounted Wingspan Stent (Boston Scientific, Fremont, CA). Continuous transcranial Doppler monitoring after stent placement indicated developing cerebral hyperperfusion. Concurrent angiography revealed markings consistent with dilatations of small arteries in the vascular territory of the stented arteries. Aggressive blood pressure management started in the procedure and continued postprocedure led to an approximately 40% reduction in systolic blood pressure. RESULTS The patient had an uneventful postoperative course and was discharged without development of neurological sequelae. Long-term (8 months) follow-up found that hemodynamic parameters in the stented left middle cerebral artery only slightly elevated compared to the unaffected right middle cerebral artery. CONCLUSION The high-resolution angiographic image described here may provide a radiologic indication of the onset or progression of cerebral hyperperfusion, permitting appropriate therapeutic management prior to serious sequelae developing. Author Affiliation: (1)From the Department of Neuroscience (MBR); and Department of Neurological Surgery, Columbia University, New York, NY (RMS, RJK, PMM). Article History: Acceptance: Received July 6, 2008, and in revised form November 26, 2008. Accepted for publication December 15, 2008. Article note: Correspondence: Adderss correspondence to Philip M. Meyers, MD, Department of Neurosurgery, Columbia University, 710 West 168th Street, Rm 428, Neurological Institute, New York NY 10032. E-mail: pmm2002@columbia.edu

The study aims to evaluate the efficacy and benefits as well as risks of dual antiplatelet therapy in patients having undergone implantation of drug-eluting stents. The results indicate that such therapy used for a period longer than 12 months was found to be as effective as aspirin monotherapy in reducing the risk of myocardial infarction.

A study was conducted to evaluate the efficacy of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation. Results indicated that the predictive accuracy of the tests was only modest and thus were not accurate predictors.

The study aims to evaluate and compare stent graft as against conventional balloon angioplasty in patients with failing dialysis-access grafts. The results indicate that stent graft was found to be more effective and beneficial in such cases.

Renal insufficiency (RI) has been shown to be associated with increased major adverse cardiovascular events after percutaneous coronary intervention. We reviewed the impact of Rl on the pathogenesis of coronary [...]