ABSTRACT
The role of metallic stents in the palliation of esophageal cancer is well established. Self-expanding metal stents (SEMSs) are frequently used, as they provide an effective and safe method of relieving malignant dysphagia. A number of complications are associated with the use of SEMSs, including esophageal perforation. We report a case of thoracic discitis occurring in a patient with advanced esophageal malignancy, treated with SEMSs. We propose that the likely etiology in this patient was esophageal perforation by a metallic stent.
Subject(s)
Carcinoma, Squamous Cell/therapy , Discitis/etiology , Esophageal Neoplasms/therapy , Esophageal Perforation/complications , Esophageal Stenosis/therapy , Methicillin-Resistant Staphylococcus aureus , Palliative Care , Staphylococcal Infections/etiology , Stents/adverse effects , Thoracic Vertebrae , Aged , Anti-Bacterial Agents/therapeutic use , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/pathology , Discitis/diagnosis , Discitis/therapy , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/pathology , Esophageal Perforation/diagnosis , Esophageal Stenosis/diagnosis , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Neoplasm Staging , Spinal Cord Compression/diagnosis , Spinal Cord Compression/etiology , Spinal Cord Compression/therapy , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , Tomography, X-Ray ComputedABSTRACT
Prostate carcinoma presenting initially as supraclavicular lymphadenopathy has been increasingly reported as an uncommon presentation of the disease. The diagnosis is often made on lymph node biopsy as these patients rarely undergo digital rectal examination or serum prostate-specific antigen level measurement as part of their initial investigations. A 74-year-old man presented with supraclavicular lymphadenopathy and subsequently deteriorated with severe shortness of breath associated with venous congestion of the head and neck. The diagnosis of metastatic prostate adenocarcinoma was made only after cervical lymph node biopsy. Following the diagnosis, he was confirmed as having an abnormal prostate on digital rectal examination and a raised serum prostate-specific antigen level. The authors propose that a digital rectal examination and a serum prostate specific antigen level be included in the initial investigation process of male patients with persistent supraclavicular lymphadenopathy. This would prevent delay in diagnosis, allow early intervention and decrease patient morbidity.
Subject(s)
Adenocarcinoma/secondary , Jugular Veins , Lymphatic Diseases/pathology , Prostatic Neoplasms , Thrombosis/etiology , Aged , Digital Rectal Examination , Humans , Male , Prostate-Specific Antigen/analysis , Prostatic Neoplasms/diagnosisABSTRACT
OBJECTIVES: Cerebral vasospasm remains the leading cause of death and permanent disability after subarachnoid haemorrhage. This study determined whether the method of aneurysm treatment plays an important role in determining the incidence of cerebral vasospasm and its clinical consequences. METHODS: Admission data, cranial computed tomography (CT), treatment details, transcranial Doppler (TCD) results, and clinical outcomes of patients who had surgical or endovascular management of their ruptured aneurysm were recorded and subject to multivariate analysis. RESULTS: Between January 1995 and December 1999, 292 eligible patients (206 female, 86 male) had definitive aneurysm treatment at our unit. 212 patients were clipped, 80 coiled. There was no significant difference in patient age, pre-treatment neurological grade, Fisher grade, or timing of treatment in the two groups. 48.3% patients developed TCD detected cerebral vasospasm and 16.1% patients developed permanent ischaemic neurological deficit. At clinical follow up, 84.2% of patients were well (mGOS 1 and 2) with a cumulative death rate of 6.5% from all causes. The only significant predictor of TCD-detected cerebral vasospasm was patient age (inversely, p = 0.004). Increased patient age, vasospasm, poor pre-treatment WFNS, and higher CT Fisher grades correlated with a poor discharge GOS. However, only poor pre-treatment WFNS grade and patient age correlated with poor GOS at follow up (p<0.001). CONCLUSION: The treatment method had no influence on the incidence or duration of TCD detected vasospasm and there was no significant difference in outcome at discharge or follow up between those patients who had surgery or endovascular management of their aneurysms.