Dysphagia Lusoria - A Rare Cause of Prolonged Dysphagia

A 64-year-old man presented with prolonged history of intermittent dysphagia with sensation of food sticking at his upper chest. Physical examination was unremarkable, and an upper endoscopy did not reveal the underlying cause. On computed tomography scan of thorax, an aberrant right subclavian artery was seen coursing posterior to the esophagus resulting in external compression, which is a typical radiological feature of Dysphagia Lusoria. The pathophysiology, clinical features, imaging features and updated treatment modalities of this rare disease are discussed.

Stent-assisted percutaneous angioplasty for extra-cranial carotid disease:experience at Singapore General Hospital

<p><b>INTRODUCTION</b>This study aims to analyse the results of carotid stenting in a tertiary referral centre in Singapore.</p><p><b>MATERIALS AND METHODS</b>Retrospective analysis of all carotid artery stenting (CAS) cases in a single centre from March 1997 to December 2008 was performed. Sixty successful procedures were performed in 61 patients, with bilateral stenting in 1 patient, and 2 failed procedures. The majority were Chinese (78.7%) and males (77.0%), with a high proportion having hypertension (82.0%) and hypercholesterolaemia (78.7%). The majority (91.8%) of patients were high surgical risk candidates, primarily due to cardiac risk factors. Ten patients (16.4%) had prior neck irradiation for nasopharyngeal carcinoma, and 3 patients each (4.9%) had previous endarterectomy and contralateral occlusion. A distal embolic protection device was used in 71.7% of cases.</p><p><b>RESULTS</b>Technical success was 96.8%. The 30-day stroke and death rate was 13.8%, comparable to reported results for this high surgical risk population.</p><p><b>CONCLUSION</b>CAS is a technically feasible and a relatively safe alternative to endarterectomy to treat extracranial carotid stenosis, especially in patients who are inoperable or at high surgical risk.</p>