Retrograde Radiological Gastrostomy Technique and Retrograde Stent Placement in a Completely Occluded Cervical Esophagus.

Malignant obstruction of the cervical esophagus presents some anatomical and technical challenges when considering radiologic or endoscopic intervention. This case report describes the failure of antegrade access to place a gastrostomy tube and stent due to complete luminal occlusion from an esophageal tumor. The ultrasound-guided percutaneous gastric puncture was performed to achieve retrograde pneumodistension to allow radiologic gastrostomy insertion. Subsequently, the cervical esophagus was retrogradely cannulated via insertion of a guidewire from the gastrostomy site. A distal release esophageal stent was then inserted over the wire and deployed from the mouth in an antegrade manner. However, due to the unpredictable proximal shortening of distal release stents, this stent was eventually shortened and displaced so that it no longer covered the top of the tumor stricture, and further antegrade access failed. Once more, a retrograde access approach was adopted via the gastrostomy stoma, a guidewire and catheter were passed retrogradely through the original stent and out through the mouth. A distal release stent system was then inserted in a retrograde manner via the gastrostomy stoma, effectively making it a proximal release stent which enabled more precise positioning of the stent above the tumor. Palliation was achieved until death, and beyond expected mean survival.

Oesophageal stenting: Status quo and future challenges.

Oesophageal stents are widely used for palliating dysphagia from malignant obstruction. They are also used with increasing frequency in the treatment of oesophageal perforation, as well as benign strictures from a variety of causes. Improved oncological treatments have led to prolonged survival of patients treated with palliative intent; as a consequence, stents need to function and last longer in order to avoid repeat procedures. There is also increasing need for meticulous procedure planning, careful selection of the device most appropriate for the individual patient and planned follow-up. Furthermore, as more patients are cured, there will be more issues with resultant long-term side-effects, such as recalcitrant strictures due to radiotherapy or anastomotic scarring, which will have to be addressed. Stent design needs to keep up with the progress of cancer treatment, in order to offer patients the best possible long-term result. This review article attempts to illustrate the changing realities in oesophageal stenting, differences in current stent designs and behaviour, as well as the pressing need to refine and modify devices in order to meet the new challenges.

Discursive and scientific psychology.

I begin with the origins of Loughborough University's Discourse and Rhetoric Group (DARG), and in particular discursive psychology (DP). Rather than attempting to summarize DP, versions of which are plentiful, the article attempts to clarify various relationships and tensions between DP and other kinds of social psychology, particularly experimental. Common sense psychology is defined as DP's topic rather than rival; the aim is to study how people deploy everyday psychological notions and manage psychological business within talk and text, and what they accomplish by such deployments, rather than trying, as experimental psychology is often characterized as doing, to replace it all with something purportedly better. Claims for DP being particularly interpretative rather than scientific are rejected, by appeal to an 'interpretative gap' between phenomena, data, analysis, and conclusions that all research must manage, that gap being often much larger in quantitative and experimental work. The importance of pursuing causal explanations of psychological phenomena is questioned, and the importance asserted, of discovering, through rigorous empirical and conceptual analysis, the normative bases of human conduct and accountability.

Contribution of onset/offset information of modulation to amplitude modulation depth discrimination.

A previous study by [J. Lee, G. Long, and C. Jeung, J. Acoust. Soc. Am. 119, S3332 (2006)] found that information at the onset or offset of modulation could be utilized for improved amplitude modulation (AM) depth discrimination in a continuous carrier condition (carrier presented 250 ms earlier and later than the modulator). In this study, the relative contribution of information at the onset or offset of the modulation was examined with an onset-fringe carrier condition (carrier begins 250 ms earlier than the modulator) and an offset-fringe condition (carrier ends 250 ms later than the modulator). The results suggest that modulation information at the onset might be utilized more than at the offset.

Bill and Monica: memory, emotion and normativity in Clinton's Grand Jury testimony.

We examine links between factual recall, emotion and constructions of normativity in narrative accounts, using as an empirical case President Clinton's descriptions of his relationship with Monica Lewinsky. We analyse those accounts in the sequences of talk in which they occurred, under Grand Jury cross-examination. Clinton's accounts of Lewinsky were part of how he attended to issues alive in court concerning himself, including his possible exploitation and abuse of power in an asymmetrical relationship; his motives, sincerity, credibility and intentions; and, indirectly, his fitness for office as President. Analysis focuses on how Clinton's portrayal of Lewinsky accomplished a reflexive portrayal of himself, not as mendacious and exploitative, but as caring, responsible, sincere, rational and consistent, while reducing the scope and implications of their admitted sexual relationship. This study is linked to a broader discursive psychology of factual description, memory, mental and emotional states, and their relevance to the larger business of institutional settings.