[Covered self-expanding metal stent in palliative treatment of dysphagic patient with end-stage malignancy of cardia: the first experience in stent placement and literature review]

Background: More than 50% of patients with carcinoma of the esophagus or gastric cardia have incurable disease at presentation and require palliative treatment for dysphagia. lnsertion of a self-expanding metal stent has become the treatment of choice for these patients. We report successful placement of a covered self-expanding metal stent in a patient with malignant squamous cell carcinoma [SCC] of esophagogastric junction

Case report: A 62-year-old man referred to the gastrointestinal division of the 501 medical center, Tehran, lran due to dysphagia. During upper gastrointestinal endoscopy, a seven cm tumor was seen 35 cm distal to dental line. Histologic examination of the biopsy samples confirmed malignant SCC. The tumor was in stage lll/lV and therefore it was inoperable. Palliative therapy with 11-cm covered Choo stent [Ml-Tech Ltd., Seoul, South Korea] was considered for this patient. On March 12, 2006 after sedation with midazolam, the stent was placed under the fluoroscopic and endoscopic guide. The patient underwent radiotherapy, thereafter. During the two-month follow-up, the patient's general condition recovered and he gained weight

Conclusions: Fluoroscopically guided insertion of covered self-expanding metal stents is a safe and comfortable method of palliation for patients suffering with malignant dysphagia. For prevention of restenosis, covered types should be given priority

Covered self-expanding metal stent in palliative treatment of dysphagic patient with end-stage malignancy of cardia: the first experience in stent placement and literature review

More than 50% of patients with carcinoma of the esophagus or gastric cardia have incurable disease at presentation and require palliative treatment for dysphagia. Insertion of a self-expanding metal stent has become the treatment of choice for these patients. We report successful placement of a covered self-expanding metal stent in a patient with malignant squamous cell carcinoma [SCC] of esophagogastric junction. A 62-year-old man referred to the gastrointestinal division of the 501 medical center, Tehran, Iran due to dysphagia. During upper gastrointestinal endoscopy, a seven cm tumor was seen 35 cm distal to dental line. Histologic examination of the biopsy samples confirmed malignant SCC. The tumor was in stage Ill/IV and therefore it was inoperable. Palliative therapy with 11-cm covered Choo stent [Mi-Tech Ltd., Seoul, South Korea] was considered for this patient. On March 12, 2006 after sedation with midazolam, the stent was placed under the fluoroscopic and endoscopic guide. The patient underwent radiotherapy, thereafter. During the two-month follow-up, the patient's general condition recovered and he gained weight. Fluoroscopically guided insertion of covered self-expanding metal stents is a safe and comfortable method of palliation for patients suffering with malignant dysphagia. For prevention of restenosis, covered types should be given priority

Effects of training programs of pregnant women on their delivery type selection: a single blind randomized control trial

There has been an increasing demand for cesarean section delivery [C/S] by pregnant women in recent years. This increase in demand, not only adversely affects the rate of delivery complications, but also imposes a great amount of extra expenses on families, government and insurance companies. It was assumed that by training programs for pregnant women during their prenatal care visits, they can play an active role in the process of decision-making regarding their type of delivery. The goal of the present study is to determine the effect of such training programs on pregnant women in selecting the type of the delivery and to specify if the current rate of C/S can be change by such training programs. In this single-blind randomized control trial, 200 primi-par pregnant women [age 18-30 years old] with gestational ages of less than 30 weeks, referring to the Ob-Gyn clinic of Be'sat general Hospital [IRIAF central hospital] for prenatal care were included.These pregnant women were randomly divided into two groups: Group A which received planned training program during their pregnancy and group B with no training program. None of the assessors knew about the women's status in the mentioned groups. Distribution of women in both groups were equal considering factors like age, education, profession and selected method of delivery at their first interview. In group A, films and pamphlets were used for training. Pamphlets were explained by professional midwives. Patients visited the Ob-Gyn department and delivery ward and spoke to women in their post-delivery phase. At their 36 week of gestational age, all patients in both groups were interviewed again and data were collected and analyzed by proper software using chi square test. In group A, the level of patient's awareness regarding Normal Vaginal Delivery [NVD] and cesarean section [C/S] was markedly increased, expectedly [78%vs.4%] and [71% vs. 4%], while in group B the level of patient's awareness did not changed on their second interview. The rate of selecting C/S in group A [test] was markedly reduced [25%vs. 39%], [p < 0.05], while there were no changes in this rate among patients in group B [40% vs. 41%]. can be concluded that basic trainings for pregnant women can effectively reduce the rate of demand for C/S delivery. It is therefore, recommended that this kind of training to be available for all patient [regardless of their level of education] referring to prenatal care clinics

[Effects of training programs of pregnant women on their delivery type selection: a single blind, randomized control trial]

Background: There has been an increasing demand for cesarean section delivery [C/S] by pregnant women in recent years. This increase in demand, not only adversely affects the rate of delivery complications, but also imposes a great amount of extra expenses on families, government and insurance companies. It was assumed that by training programs for pregnant women during their prenatal care visits, they can play an active role in the process of decision-making regarding their type of delivery. The goal of the present study is to determine the effect of such training programs on pregnant women in selecting the type of the delivery and to specify if the current rate of C/S can be change by such training programs

Material and methods: In this single-blind randomized control trial, 200 primi-par pregnant women [age 18-30 years old] with gestational ages of less than 30 weeks, referring to the Ob-Gyn clinic of Be'sat general Hospital [IRIAF central hospital] for prenatal care were included. These pregnant women were randomly divided into two groups: Group A which received planned training program during their pregnancy and group B with no training program. None of the assessors knew about the women's status in the mentioned groups. Distribution of women in both groups were equal considering factors like age, education, profession and selected method of delivery at their first interview. In group A, films and pamphlets were used for training. Pamph lets were explained by professional midwives. Patients visited the Ob-Gyn department and delivery ward and spoke to women in their post-delivery phase. At their 36th week of gestational age, all patients in both groups were interviewed again and data were collected and analyzed by proper software using chi square test

Results: In group A, the level of patient's awareness regarding Normal Vaginal Delivery [NVD] and cesarean section [C/S] was markedly increased, expectedly [78%vs.4%] and [71 % vs. 4%], while in group B the level of patient's awareness did not changed on their second interview. The rate of selecting C/S in group A [test] was markedly reduced, [25%vs. 39%], [p < 0.05], while there were no changes in this rate among patients in group B [40% vs. 41%]

Conclusions: It can be concluded that basic trainings for pregnant women can effectively reduce the rate of demand for C/S delivery. It is therefore, recommended that this kind of training to be available for all patient [regardless of their level of education] referring to prenatal care clinics