Rectal injury during permanent seed implantation for prostate brachytherapy.

Serious complications have not been previously reported during seed implantation for prostate brachytherapy. We present an unreported case of rectal injury caused by an ultrasound probe. A 67-year-old male presented with a serum prostate-specific antigen level of 5.50 ng/ml, a Gleason score of 7 (3 + 4) and clinical T2a adenocarcinoma of the prostate. A transperineal permanent prostate brachytherapy implantation was performed. The patient subsequently complained of abdominal pain postoperatively. A gastrointestinal perforation was suspected based on an abdominal X-ray obtained on the day after the brachytherapy. Rectal injury was recognized during an exploratory laparotomy, and a primary closure and temporary diversion ileostomy were performed. The healing of the injury was confirmed by colonoscopy and an ileostomy closure was performed 2 months after the temporary diversion. The investigating committee for this accident concluded that the ultrasound probe had perforated the rectum. This is the first case of a rectal injury during seed implantation for prostate brachytherapy.

[Airway stent for airway obstruction caused by esophageal carcinoma].

The result of airway stent and adjuvant therapy for airway obstruction caused by advanced esophageal carcinoma was evaluated. In Tokyo Metropolitan Ohkubo Hospital, four cases of esophageal carcinoma with airway obstruction were treated by tracheo-bronchial stent. Two were primary cases and the others were recurrent cases. Three of the patients demonstrated progressive dyspnea due to airway obstruction, and the other complained of bloody discharge. An ultraflex non-covered stent was used cases. After insertion of the airway stent. The patients' dyspnea improved immediately. One patient was discharged without adjuvant treatment, and died of the cancer one month later. Adjuvant treatment was adopted in the other three cases. The size of the tumor decreased, but fistula formation was observed in two cases. An airway stent is an effective treatment with immediate results for dyspnea caused by airway obstruction. Adjuvant treatment after stent placement is often associated with fistula formation. It should be considered carefully.