Biomedical subjects
Publications and source records attributed to A F Watkinson.
A 74-year-old man presented with a right common iliac artery aneurysm and bilateral common femoral artery aneurysms. These aneurysms were repaired by a hybrid procedure. A one-stage approach was chosen including an endovascular stent-graft and femoro-iliaco-femoral Y-bypass grafting. The authors describe a novel combined open and endovascular approach to repair these complex aneurysms.
BACKGROUND: This study compared the value of contrast-enhanced helical computed tomography (CT), CT during arterioportography (CTAP), and contrast-enhanced magnetic resonance imaging (MRI) for staging patients with colorectal liver metastases. METHODS: One hundred and twenty patients with known or suspected colorectal liver metastases were evaluated prospectively. MRI and CTAP were performed within 3 weeks of CT in patients with potentially resectable tumours. Results of imaging were compared with findings at surgery, intraoperative ultrasonography and histological examination. RESULTS: Twenty patients were not considered for liver resection following CT. The remaining 100 patients underwent CT and CTAP, 85 of whom had CT, CTAP and MRI. The sensitivity and specificity were 73.0 and 96.5 per cent for CT, 87.1 and 89.3 per cent for CTAP, and 81.9 and 93.2 per cent for MRI. Positive predictive values were 89.7, 87.5 and 87.5 per cent respectively. Receiver-operator characteristic analysis gave an accuracy on a segment-by-segment analysis of 0.73 for CT, 0.87 for CTAP and 0.82 for MRI. Combining information from CT and CTAP, CT and MRI, or all three modalities, did not significantly increase the percentage of patients staged correctly (71, 72 and 76 per cent respectively). CONCLUSION: The diagnostic accuracy of spiral CT, MRI and CTAP was similar. Combining modalities did not improve accuracy.
Inferior vena caval obstruction (IVCO) is an occasional cause of lower limb oedema in palliative care patients with metastatic malignancy. We present five cases who underwent IVC stenting for symptomatic relief. Four of the five cases had significant reduction in their oedema but three of these four patients died within two weeks of the procedure. The procedure itself is described and the appropriateness of this intervention in patients with end-stage disease is discussed.
PURPOSE: The prognosis for advanced pancreatic cancer remains poor. Gastrin acts as a growth factor for pancreatic cancer. We describe the first study of the antigastrin immunogen G17DT in pancreatic cancer. Our aims were to determine the antibody response, safety, tolerability, and preliminary evidence of efficacy of G17DT in advanced pancreatic cancer. PATIENTS AND METHODS: Thirty patients with advanced pancreatic cancer were immunized with three doses of either 100 micro g or 250 micro g of G17DT. RESULTS: In the whole group, 20 (67%) of 30 patients produced an antibody response. The 250- micro g dose resulted in a significantly greater response rate of 82% compared with 46% for the 100- micro g group (P =.018). The most significant side effects, seen in three patients, were local abscess and/or fever. The median survival for the whole group from the date of the first immunization was 187 days; median survival was 217 days for the antibody responders and 121 days for the antibody nonresponders. The difference in survival between the antibody responders and nonresponders was significant (P =.0023). CONCLUSION: Patients with advanced pancreatic cancer are able to mount an adequate antibody response to G17DT. The 250- micro g dose is superior to the 100- micro g dose, and it appears to be generally well tolerated. Antibody responders demonstrate significantly greater survival than antibody nonresponders. Phase III studies are currently underway in order to determine efficacy.
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AIM: To evaluate the efficacy of stenting in the palliation of malignant duodenal and gastric outlet obstruction. MATERIALS AND METHODS: We retrospectively reviewed our series of patients who underwent stenting for malignant upper gastrointestinal obstruction between March 1998 and December 1999. From January 2000 data have been acquired prospectively. Our series comprises 21 stents successfully deployed in 15 patients. RESULTS: The technical and clinical success was 93% (14/15 patients). One patient required endoscopic negotiation of recurrent gastric carcinoma at the gastrojejunostomy site after failure to cross the lesion fluroscopically. Two patients required re-intervention 2 and 5 weeks after initial stent placement, for migration and ingrowth respectively. Eighteen stents were placed transorally, two stents transhepatically and one via a transgastric approach. Early complications (pain < 3 days) occurred in two patients (13%) and late complications (ingrowth, overgrowth and migration) occurred in three patients (20%). The median survival was 2.4 months (range 2-4 months). CONCLUSION: Stenting provides a less invasive palliative option than surgery with the advantage of lower morbidity and complication rates. It has the advantage of high technical and clinical success rates facilitated by alternative routes of access into the upper gastrointestinal tract via transgastric and transhepatic routes in addition to the traditional peroral route.
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Malignant tracheal stenosis presents a considerable challenge to the head and neck surgeon. The use of intraluminal stents has been previously described, but current literature notes a paucity of supportive physiological data. We describe the use of a self-expanding metallic Wallstent in the palliation of a case of papillary thyroid carcinoma. This is accompanied by significant improvement in quantitative pulmonary function.
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Carcinoid tumours are often indolent asymptomatic tumours. However, a small but significant proportion are malignant and difficult to manage. Multiple endocrine neoplasia type 1 (MEN-1) may be associated with carcinoid tumours and should therefore be considered in the investigation of these patients. This review puts into context the use of newer imaging modalities, including octreotide scintigraphy. The therapeutic treatment options are discussed, including the use of octreotide, the role of receptor-targeted therapy, hepatic-artery embolisation, and the arguments against chemotherapy. We review the need for careful patient selection when considering curative and palliative surgery, including liver transplantation. We conclude that there are now better diagnostic tools and therapeutic options available for those patients with malignant carcinoid tumours, and that these patients are best managed by a multidisciplinary approach. Earlier detection and treatment of these tumours should lead to improved quality of life and survival, which, ideally, should be assessed in formal trials.
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Superior vena cava obstruction (SVCO) is a distressing syndrome. The condition may present to specialists in many branches of medicine, but patients have traditionally been referred on to clinical oncologists for management, as malignancy is the main aetiological factor. Treatment without a histological diagnosis is no longer justified, because management needs to be tailored to the underlying disease. This article reviews the causes, symptoms, methods of diagnosis and therapy options. The role of stenting in SVCO is discussed and a management algorithm is proposed.
PURPOSE: A prospective, randomized comparison of the result of endoscopic laser therapy and that of placement of self-expandable metallic endoprostheses was performed to determine which method provides the best palliation of dysphagia in patients with inoperable esophageal carcinoma. MATERIALS AND METHODS: Sixty patients participated in the study. Twenty-three were randomly assigned to undergo plastic-covered stent placement, 19 to undergo uncovered stent placement, and 18 to undergo laser therapy. The quality of swallowing was assessed with the dysphagia score, which ranged from 0 for normal swallowing to 4 for complete dysphagia. RESULTS: The mean improvement in dysphagia score was 2 and ranged from -1 to 3 in patients who underwent placement of plastic-covered stents, was 2 and ranged from 0 to 4 in those who underwent placement of uncovered stents, and was 1 and ranged from 0 to 2 in those who underwent laser therapy. Six of 23 (26%) plastic-covered stents migrated, whereas none of the uncovered stents did so (P < .02). Tumor ingrowth through uncovered stents occurred in five of 19 patients (26%). CONCLUSION: Placement of metallic esophageal endoprostheses is substantially better than endoscopic laser therapy for palliation of dysphagia in patients with inoperable esophageal carcinoma. Use of uncovered and plastic-covered metallic stents provides equal palliation in patients with dysphagia.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
We report three cases of inferior vena cava (IVC) obstruction due to metastatic liver disease treated with a self-expanding Wallstent endoprosthesis (Schneider SA, Zurich, Switzerland). All three patients experienced symptomatic relief during their remaining few weeks of life. The Wallstent is effective and easy to deploy, and should be considered for use in the management of such patients. The literature to date on IVC stenting is also reviewed.
PURPOSE: To assess the effectiveness of a polyurethane-covered self-expanding metallic endoprosthesis in the relief of dysphagia due to irresectable esophageal carcinoma. MATERIALS AND METHODS: Thirty-two patients (20 men, 12 women) aged 41-89 years (median, 70 years) with inoperable esophageal carcinoma underwent stent placement (44 stents). All patients underwent both clinical and radiologic examination before and after treatment. Clinical follow-up was performed at 4-week intervals. RESULTS: Stent placement was successful in all patients, with good symptomatic relief and no serious complications. Eleven patients needed more than one stent because of early partial migration, late complete migration, tumor overgrowth, or long stricture. Seven patients had associated esophageal fistulization or perforation; leaks were successfully sealed after stent insertion. The mean dysphagia score was 3.38 +/- 0.49 (standard deviation) before treatment and 0.81 +/- 0.88 at 3-4 days after insertion. Nineteen patients died, with a median survival time of 78 days (range, 12-245 days), and 13 were alive 14-67 days (median, 30 days) after treatment and were swallowing a near normal diet. CONCLUSION: The insertion of plastic-covered endoprostheses provides rapid, safe, and effective palliation of malignant esophageal obstruction.