CT surveillance of the thorax in patients with squamous cell carcinoma of the head and neck: a preliminary experience.

PURPOSE: Our goal was to determine the number of malignancies detected by thoracic CT in patients with head and neck squamous cell carcinoma (SCCA) in three clinical settings. METHOD: We retrospectively examined 168 thorax CT scans in 93 patients with head and neck SCCA and determined the number of malignancies (second primary cancers or metastasis) (a) at the time of diagnosis of the primary neck tumor (57 patients), (b) at approximately yearly intervals following treatment of the primary cancer (93 examinations in 43 patients), and (c) at the time of local/regional recurrence of the neck neoplasm (18 patients). RESULTS: CT detected malignancy in 9 of 57 patients examined during diagnosis of the neck tumor, in 9 of 43 patients during follow-up, and in 6 of 18 patients evaluated at the time of local/regional neck recurrence. CONCLUSION: Chest CT demonstrates a high number of additional malignancies in patients presenting with advanced SCCA of the head and neck.

Nonexpandable silicone esophageal stents for treatment of malignant tracheoesophageal fistulas: complications and radiographic appearances.

BACKGROUND: The aim was to evaluate the radiologic appearances and complications that occurred after placement of nonexpandable silicone stents used as palliative therapy for patients with malignant tracheoesophageal fistulas (TEFs). METHODS: Records of 11 patients (6 males, 5 females) who underwent placement of esophageal stents for malignant TEF between 1988 and 1994 were reviewed. Nine patients had esophageal carcinoma and two patients bronchogenic carcinoma. A TEF was documented radiographically in all patients. Silicone stents were placed in all patients under endoscopic guidance. A chest radiograph was obtained for each patient immediately following stent placement to confirm proper positioning and to assess complications. A contrast study was performed within 24 hours after the procedure to evaluate the function of the stent and its efficacy for occluding the fistulous tract. The patients were followed until January 1995 or until their death (range 1.5-24. 0 months). RESULTS: Seven of the patients developed stent-related complications. Within the first 24 hours after stent insertion (which was successful in 100% of cases), 2 of the 11 patients developed minor complications. One patient had pooling of contrast around the proximal portion of the stent leading to aspiration of contrast, and one patient experienced transient, asymptomatic, idiopathic, esophagovenous intravasation. Delayed (>24 hours) complications related to stent placement occurred in five of the patients: one patient each had pooling at the proximal end of the stent with aspiration, worsening esophageal dysphagia causing reflux through the stent, caudad stent migration, superior stent migration, epithelial hyperplasia causing obstruction of the stent, and pressure necrosis. There were no cases of hemorrhage. Two patients were lost to long-term follow-up, and eight patients died of their disease, all unrelated to the stent placement. CONCLUSION: Silicone esophageal stents provide successful short-term palliation for most patients with malignant TEF but are not without associated complications. These complications, however, can usually be detected early using radiographic imaging, permitting remediation.

An unusual presentation of Zenker's diverticulum.

Zenker's diverticula are esophageal outpouchings in the region of the cricopharyngeus which typically grow in a posterolateral and inferior direction and can cause esophageal compression if the diverticulum is large enough. We describe a patient in whom a Zenker's diverticulum expanded posteriorly and superiorly so that it was positioned in the posterior pharyngeal space, causing both esophageal and tracheal narrowing.

CT of vesicocorporeal fistula with menouria: a complication of uterine biopsy.

Vesicouterine fistulas are a rare complication of obstetrical-gynecological interventions and are the least common of the acquired urogenital fistulas. They are almost solely associated with cesarean section. A case is reported in which a patient with adenomyosis and pelvic adhesions presented with menouria (vesical menstruation) after uterine biopsy. A vesicocorporeal fistula was demonstrated by cystography and CT and confirmed by cystoscopy and hysteroscopy.

[Cholecystectomy via laparoscopy: one and a half year's experience]. / Colecistectomía por laparoscopia. 1 año y medio de experiencia.

Results of the first 175 laparoscopic cholecystectomies performed at our hospital over the last 18 months were reviewed. In 17 (9.7%) of cases, due to operatory complications, and in some cases due to instrumental deficiencies, we were obliged to perform conventional laparotomy. In 8 patients, we performed simultaneous alternative surgery during laparoscopy. Our results were satisfactory, with no important complications, no re-operations and only 6.2% of minor complications. Hospital stay was low (2.5 days), and after 10 days patients returned to normal life.