FCSEMS treat biliary leaks effectively, but carry a relatively high stricture risk in patients who have received liver transplants. FCSEMS cannot be recommended for management of biliary leaks following liver transplantation at this point.

SUMMARYMetallic pyloric stenting (also termed as metallic enteral stenting) performed endoscopically, stands as first-line treatment for malignant gastric outlet obstruction. With reported evidence, these self-expandable metallic stents (SEMS) re-enable oral food intake, preventing patients having to face invasive techniques such as surgical gastroenterostomy. We report a patient having received a covered pyloric SEMS insertion following a tumour growth causing stenosis in the gastric antropyloric region. After 3 weeks, the patient presented with a fracture of the pyloric SEMS, a rare complication, resulting in a second pyloric SEMS insertion. BACKGROUND

We have previously documented abnormalities in cardiac structure in patients with adult-onset growth hormone deficiency (GHD) and acromegaly which partially resolved during treatment (Dattani et al. 2012, Zemrak et al. 2012). No treatment effect was seen on global measures of cardiac function e.g. left ventricular ejection fraction. The aim of this study was to use quantitative strain parameters from cardiac magnetic resonance (CMR) myocardial feature tracking (FT) to assess regional changes in function before and after treatment in patients with GHD and acromegaly. Methods 10 patients with GHD, 13 patients with acromegaly and 23 age-and sex-matched normal controls underwent CMR. Patients underwent scanning before and again 12 months after treatment. Radial and circumferential strain parameters were derived from 2-chamber (2CH), 4-chamber

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A 59-year-old woman was admitted to our hospital with acute pulmonary oedema and cardiogenic shock 35 days after anterior ST elevation myocardial infarction. She developed a new loud pan systolic murmur. Echocardiography revealed a ventricular septal rupture with a significant left to right shunt. She was immediately transferred to the local cardiothoracic unit where she underwent a successful ventricular septal defect (VSD) repair. Ventricular septal rupture often presents within the first 24 hours of acute myocardial infarction and is rare thereafter. It carries a poor mortality (41-80%) even when recognised. Timely recognition of this life-threatening complication can help reduce the resultant morbidity and mortality. Doctors should be aware that this well-recognised complication may present unusually late as in this case.