Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.

A 74-year-old female with idiopathic myelofibrosis (IMF) was admitted to our hospital because of massive hematemesis and melena. Immediate upper gastrointestinal endoscopy revealed an intermittent spurting hemorrhage from extensive esophageal varices. Endoscopic injection sclerotherapy (EIS) was carried out and the bleeding ceased. After five courses of EIS, all the esophageal varices were eradicated. About 15 months later, the patient died, due to a cerebral hemorrhage, without further variceal bleeding. A postmortem examination was carried out and the portal hypertension was considered to be due not only to extramedullary hematopoiesis in the sinusoids, but also to increased splenic blood flow. We are confident that EIS is an effective therapeutic procedure for patients with IMF showing esophageal variceal hemorrhage. EIS should be the preferred choice of treatment for esophageal varices in patients with IMF, since it is less invasive than splenectomy.

No abstract

Endoscopic placement of Wallstents was thought to be a less invasive procedure, and in previous publications serious complications were infrequent. We report here on the case of a 58-year-old man with unresectable pancreatic cancer who developed emphysematous cholecystitis after endoscopic placement of a Wallstent, which was further complicated by distal migration of the stent. A second stent had to be placed into the first to fully bridge the malignant stricture. Three days later, the patient developed cholecystitis and septic complications, and he finally died of septic shock with disseminated intravascular coagulation. This previously unreported complication should be considered if abdominal pain and high fever develop after Wallstent placement.

No abstract