Volume 64 - 2001 - Fasc.4 - Case series
Treatment of malignant biliary stenosis : which stent to use ?
The insertion of a biliary endoprosthesis has become standard therapy in the palliative treatment of a malignant biliary stenosis. For plastic stents, stent occlusion results from clogging caused by the adherence of proteins, bacteria, and sludge to the inner stent wall, resulting in a median stent patency of about 4 to 5 months. No major gain in stent patency can be obtained by the omission of side holes, nor by changes in stent material. Putting the stent inside the bile duct, in a suprapapillary position, does not lead to a longer stent patency. The prophylactic administration of antibiotic agents such as ciprofloxacin or norfloxacin, that are active against the gram-negative enterobacteriaceae leading to stent clogging, could have potential advantages but still needs further study. The insertion of a straight 10 French gauge polyethylene Amsterdam-type of prosthesis in a normal transpapillary position, and without the administration of any prophylactic antibiotic treatment, can still be regarded as state-of-the-art therapy with a plastic stent. This mainly holds true for those patients with a low life expectancy of only a few months, such as it is often the case in patients in a poor clinical condition, with liver metastasis, or with a large primary tumor. Patients with a longer life expectancy can be treated with a self-expandable metallic stent. At present, there is no major indication that coated metallic stents will perform any better than the uncoated ones.
Recent insights into pathophysiology of sepsis-associated liver dysfunction
As many of 54% of patients admitted to the Intensive Care Unit (ICU) have abnormal liver function tests (1) and jaundice has been documented in as many as 44% (2) of patients admitted to the ICU because of sepsis, trauma, major surgery, and/or extensive tissue damage. Of these, sepsis appears to be the most common precipitating factor. Severity of jaundice increases with the number of organs failing and correlates with mortality (2). The aim of the present review is to reexamine recent pathophysiological da3
