Biomedical subjects

A Sommer

Publications and source records attributed to A Sommer.

At least 145 records · Page 8Linked to original sources

PubMed1995

Diabetes, intraocular pressure, and primary open-angle glaucoma in the Baltimore Eye Survey.

BACKGROUND: The association of diabetes with primary-open angle glaucoma (POAG) has been controversial and often confused by varying definitions of both diabetes and POAG. The purpose of this study is to evaluate this association in a population-based sample of subjects from the Baltimore Eye Survey. METHODS: A stratified sample of residents in 16 cluster areas of east Baltimore was recruited for a detailed ophthalmologic screening examination. A total of 5308 black subjects and white subjects participated. Of these participants, 161 received a diagnosis of POAG. During a detailed interview with each subject, diabetes was defined based on a reported history of diabetes. Persons with diabetes were classified as "insulin-users" and "noninsulin-users" based on their current method of treatment. RESULTS: Diabetes was highly prevalent in this population, with 10.6% of white subjects and 17.2% of black subjects reporting a positive history. Diabetes was associated with higher intraocular pressure, but differences were not large (means, 17.4, 18.0, and 17.8 mmHg) among subjects without diabetes, those with diabetes who were not using insulin, and those with diabetes who were using insulin, respectively. Diabetes was not associated with POAG (age-race-adjusted odds ratio, 1.03; 95% confidence interval, 0.85, 1.25). This was true for both types of diabetes. Persons whose POAG had been diagnosed before the examination showed a positive association with diabetes (odds ratio, 1.7, 95% confidence interval, 1.03, 2.86), indicating that selection bias could explain the positive results of previous clinic-based investigations. CONCLUSION: There is no evidence from this population-based investigation that supports an association between diabetes and POAG.

Adult↗

PubMed1995

Automated perimetry detects visual field loss before manual Goldmann perimetry.

PURPOSE: To determine if automated perimetry detects visual field defects before manual Goldmann perimetry. METHODS: Subjects with ocular hypertension without field loss on detailed manual perimetry were followed prospectively with annual automated and manual perimetry. Subjects with field loss on manual perimetry were age-matched post hoc to subjects who did not have field loss. The automated fields 1 year before the development of field loss on manual perimetry were compared between the two groups. Subjects were recruited from ophthalmologists' offices, eye clinics, and a population-based glaucoma survey in the Baltimore area. Abnormal results detected on the Humphrey Field Analyzer were defined using the glaucoma hemifield test, mean defect, and corrected-pattern standard deviation. RESULTS: Forty subjects who had field loss during 8 years of follow-up were compared with 145 control subjects with ocular hypertension who did not have defects. Seventy-five percent of converters had abnormal results of the glaucoma hemifield test 1 year before field loss on manual perimetry, whereas 22% of controls had abnormal results of the glaucoma hemifield test (odds ratio, 13.4). The odds ratio of field loss developing on manual perimetry within 12 months was 3.3 for those with borderline results of the glaucoma hemifield test relative to the control subjects. The odds ratio was 6.0 for corrected-pattern standard deviation (P < 0.05) and 3.9 for mean deviation (P < 0.05). CONCLUSIONS: Those with field loss on manual perimetry were more likely to have had an abnormal automated field 1 year before conversion than those who did not convert. However, 22% of subjects in whom definitive field loss did not develop on manual perimetry during the study had abnormal automated fields at one visit and 15% had abnormal automated fields on two consecutive visits.

Aged↗

PubMed1995

Relief of malignant external gastric obstruction by endoscopic implantation of a self-expanding metal stent.

We report on the case of a 63-year-old woman with a gastric stenosis caused by peritoneal carcinomatosis. Vomiting and nausea disappeared after the implantation of a self-expanding metal stent in the 5 cm-long stenosis, and the patient was able to maintain a normal diet. She was discharged from hospital and remained in good condition for 14 weeks. Then, 16 weeks after stent implantation, the patient died of metastatic tumor spread, having remained free of nausea and vomiting. An autopsy showed complete patency of the stent, and no signs of ulceration or tumor ingrowth. The success of the treatment in this patient suggests the importance of further investigations.

Endoscopy↗

PubMed1995

[Digestibility of ungraded crude protein from the rumen and of treated protein feeds in the postruminal part of the digestive tracts of ruminants].

The effective degradability and intestinal digestibility of CP of untreated and with formaldehyde (F) treated sunflower press--cakes (SF), lucerne meal (LM) and field beans (FB) were measured on polycannulated bulls by "in sacco" and "mobile bag" methods. The feeds were treated by F solution in doses from 0.2; 0.4... to 2.0 g F per 100 g CP. The effective CP degradability after treatment was decreased significantly (for SF from 78 to 33%, LM from 73 to 62%, FB from 70 to 47% with max. dose of F). The effect of F was various on individual feeds. The intestinal digestibility of treated feeds, without previous incubation in the rumen, passed from abomasum to feces has been influenced with doses of F non significantly. The digestibility of FB treated with max. dose of F was lower about 20% in the part duodenum feces than in abdomasum feces. The digestibility in the part caecum--feces for all tested feeds has been decreasing with doses of F, similar as in the rumen. The intestinal digestibility of in rumen undegraded crude protein residues of SF has been influenced by the treatment positively. It increased from 43 to 82%. The effect of F on LM was very low. The digestibility has been changed from 75 to 80%.

Abomasum↗

PubMed1995

Rumen fermentation and metabolic profile in conventional and gnotobiotic lambs.

Observations were carried out of actual acidity, volatile fatty acid (VFA) concentrations, enzyme activity in the rumen, total protein, urea, total lipid and glucose in the serum of conventional (CL) and gnotobiotic lambs (GL) in the period of milk nutrition. The inoculum of gnotobiotic lambs contained Streptococcus bovis, Prevoxella ruminicola, Butyrivibrio fibrisolvens and Selenomonas ruminantium at a concentration of 1.10(6) each. Throughout the observation period the pH of the rumen contents of gnotobiotic lambs ranged within 6.5-6.8 with a significant difference at an age of 7 weeks. Total VFA concentrations in the rumen contents were increased in the CL throughout milk nutrition: the differences at 4 and 5 weeks of age were significant. Total VFA in the conventional lambs revealed an increasing tendency between weeks 4 and 7, reaching higher levels at 7 weeks of age (57.1 mmol.l-1), whereas in the gnotobiotic animals the range (24.3-30.1 mmol.l-1) was narrow and the peak occurred at 6 weeks of age. In GL significantly increased molar proportions of acetic acid were observed whereas in CL the molar proportions of propionic acid proved to be significant increased. The molar proportions of butyric and valeric acids were increased in CL but the group differences were not significant. In GL no isoacids were found. Alpha amylase (E.C.3.2.1.1.) activity of the rumen contents was significantly increased in GL between weeks 2 and 6 of age whereas cellulase (endoglucanase E.C.3.2.1.4. and cellobiohydrolase E.C.3.2.1.91.) activity was significantly increased in 4-week-old CL. Over the whole period of milk nutrition no significant differences were observed in urease (E.C.3.5.1.5.) activity of the rumen contents in the examined groups. At 5 weeks of age significantly increased total protein levels were observed in the conventional animals with maximum levels occurring at 4 weeks of age (CL-59.5 g.l-1 GL-55.3 g.l-1). Urea levels in 6-week old conventional lambs were significantly higher than in the gnotobiotic animals (CL-6.4 mmol.l-1 vs. GL-1.9 mmol.l-1). As to glycaemia no significant group differences were recorded. In the conventional animals total lipid levels were significantly increased at 1 and 6 weeks of age with a peak occurring in the first week of life (7.5 g.l-1) whereas in the gnotobiotic lambs a significant increase was observed at 3 weeks of age, the peak being recorded in 4 week-old animals (4.3 g.l-1). Throughout the period of interest the mean daily weight gains in the conventional and gnotobiotic lambs presented 0.164 and 0.162 kg, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Animal Feed↗

PubMed1995

Pupillary and visual thresholds in young children as an index of population vitamin A status.

A prototype scotopic sensitivity machine was used to evaluate pupillary and visual thresholds for 295 Indonesian children aged 1-5 y, most of whom were initially vitamin A-deficient. Subjects were tested 6 and 9 mo after receiving a high dose of vitamin A. A group of 136 older children was tested at 6 mo after dosing; all subjects underwent testing at 9 mo. After testing at 9 mo, children randomly received either a second high dose of vitamin A or placebo and were tested a final time 2 wk later. Children with abnormal pupillary thresholds had significantly higher relative dose responses (RDRs) (P < 0.01) and significantly lower serum retinol values (P = 0.05) than did normal children. The mean pupillary threshold rose (eg, retinal sensitivity fell) as vitamin A status deteriorated between 6 and 9 mo after initial dosing, and was significantly different from a group of normal American children tested previously (P < 0.001). After placebo-controlled dosing, the decline in pupillary and visual thresholds (rise in retinal sensitivity) was significant for children receiving vitamin A but not for children receiving placebo.

Aging↗

PubMed1995

Mortality of infants < 6 mo of age supplemented with vitamin A: a randomized, double-masked trial in Nepal.

The effect of supplementing 11,918 infants < 1 mo and 1-5 mo of age with vitamin A (15,000 and 30,000 micrograms retinol equivalents or 50,000 and 100,000 IU, respectively) or a placebo on subsequent 4-mo mortality was assessed in a randomized, double-masked community trial in the rural plains of Nepal. There were 130 deaths (51.6/1000 child-y) in the control group and 150 deaths (57.1/1000 child-y) in the vitamin A group, yielding a relative risk of 1.11 (95% CI: 0.86, 1.42), which is indicative of no overall effect on early infant mortality. There was a tendency for the relative risk of mortality among vitamin A recipients to rise with improved nutritional status. These results suggest that distribution of a large oral dose of vitamin A to infants < 5-6 mo of age may not benefit short-term survival. This is in contrast with the results of trials in which older infants and children in this same population were supplemented.

Diarrhea↗

PubMed1995

A common FGFR3 gene mutation in hypochondroplasia.

Hypochondroplasia is a genetic disorder of disproportionate short stature. Linkage analysis provisionally placed hypochondroplasia in the chromosome 4p 16.3 region, a location to which the FGFR3 gene has been mapped. The genotyping of a three-generation family showed no recombinants between the hypochondroplasia phenotype and three highly polymorphic markers flanking the FGFR3 gene. Mutation analysis was performed by RT-PCR and direct sequencing. Primers covering most of the coding sequence of the FGFR3 gene were used for RT-PCR of FGFR3 mRNA and PCR amplification of genomic DNA. A C-->A transversion was detected in nucleotide 1659 predicting an N540K substitution in exon 11 which encodes part of the TK1 domain. The same mutation was found in an individual suspected to be an achondroplasia/hypochondroplasia compound phenotype and affected individuals from three other unrelated families. A second mutation, a C-->G transversion, also in nucleotide 1659 was detected in all affected individuals of another family. The latter also predicts an N540K substitution. These findings establish that a common mutation in the FGFR3 gene underlies hypochondroplasia.

Amino Acid Sequence↗

PubMed1995

Night blindness is prevalent during pregnancy and lactation in rural Nepal.

The prevalence of night blindness during pregnancy and lactation was assessed in a sample of 426 women living in the rural terai of Nepal. These women were also examined for ocular signs of vitamin A deficiency. Among 241 lactating women, 16.2% reported experiencing night blindness at some time during the pregnancy that produced the infant they were now breast-feeding. Among 185 pregnant women, 8.1% reported being night-blind at the time of the interview. The odds of night blindness in the current pregnancy were six times greater for women who reported night blindness in their previous pregnancy. Night-blind women were more likely to come from households with lower socioeconomic status. Teenage women and those over the age of 30 were at highest risk, particularly those of higher parity within these age groups. Vitamin A deficiency, for which night blindness is a marker, seems to be a problem in this population of pregnant and lactating women, with potential health consequences for women and their infants.

Adolescent↗

PubMed1995

Recurrence of duodenal ulcers during five years of follow-up after cure of Helicobacter pylori infection.

BACKGROUND: Chronic Helicobacter pylori-associated gastritis is now widely accepted as one of the most important pathogenic factors in duodenal ulcer disease. However, little is known about for how long patients remain free of duodenal ulcer relapses after H. pylori infection has been cured. In the present study, we investigated remission time during a 5-year follow-up period after anti-H. pylori treatment. METHODS: The patients were randomly allocated to treatment with either a combination of 3 x 600 mg bismuth subsalicylate and 2 x 1000 mg amoxycillin or 3 x 600 mg bismuth subsalicylate monotherapy. Endoscopy, including histological and microbiological examination of biopsies, was performed 4 weeks after termination of treatment and after 1 and 2 years. During the third, fourth and fifth years of the follow-up period, patients were monitored twice a year for symptoms compatible with ulcer relapse and for their use of anti-ulcer medication. Endoscopic and histological examinations were carried out whenever symptoms occurred. RESULTS: Of 56 evaluated patients, 47 showed healing of ulcers after bismuth subsalicylate plus amoxycillin compared with 44 of 57 after bismuth subsalicylate monotherapy. H. pylori infection was cured in 52% (29 of 56) of the patients after combined therapy and in 4% (2 of 57) after the monotherapy. The cumulative duodenal ulcer relapse rates after 5 years were 38% (18 of 47) after the combined therapy and 75% (33 of 44) after the monotherapy. In patients who were cured of H. pylori infection, the cumulative duodenal ulcer relapse rate after 5 years was 9.7% (3 of 31), compared with 81.7% (49 of 60) in those patients who remained H. pylori-positive after treatment (P < 0.001). In two of the three patients who suffered duodenal ulcer relapse after being cured of H. pylori infection, H. pylori was present again at the time of relapse. CONCLUSION: The data suggest that curing H. pylori infection results in long-term cure of duodenal ulcer disease and that duodenal ulcer relapses in successfully treated patients are most often associated with H. pylori reinfection.

Adolescent↗

PubMed1995

Two-year follow-up of duodenal ulcer patients treated with omeprazole and amoxicillin.

The present study evaluated the time in remission during a 2-year follow-up after eradication of Helicobacter pylori (HP) in patients with an HP-associated duodenal ulcer (DU). HP was eradicated by combined treatment with high-dose omeprazole (2 x 40 mg) and amoxicillin (2 x 1,000 mg; n = 27) administered for 10 days (OME + AMX); alternatively, patients were treated with omeprazole monotherapy (OME) using the same dosage (n = 25). During the 2-year follow-up period endoscopy including histological examination was performed after 1 and 2 years or whenever symptoms compatible with ulcer relapse occurred. HP eradication was achieved in 82% of the OME + AMX group, but in 0% of the OME group. The cumulative DU relapse rates were 0% after 1 year and 7% after 2 years in 22 patients who became HP-negative. Both HP-negative patients who relapsed in the 2nd year of follow-up were HP-positive again at the time of relapse. Of the 5 patients who were not eradicated after OME + AMX therapy, 2 relapsed within the 1st year (40%) and another 2 within the 2nd year (80%). In the OME group the cumulative relapse rates within 1 and 2 years of follow-up were 52 and 76%, respectively. The results further confirm that eradication of HP with combined OME + AMX treatment leads to a distinct decrease in DU relapse rates and thus may cure DU disease. Long-term eradication with combined OME + AMX treatment is possible, and the rate of reinfection with HP is low (4.5%/year).

Amoxicillin↗

PubMed1995

Nitric oxide generation during cellular metabolization of the diabetogenic N-methyl-N-nitroso-urea streptozotozin contributes to islet cell DNA damage.

The N-methyl-N-nitroso-urea streptozotocin is an antibiotic with diabetogenic, carcinogenic and antitumor activity thought to act via alkylation of DNA and proteins. Evidence points to a release of bioactive nitric oxide (NO) from streptozotocin as an additional cytotoxic activity of this drug. Here we show by EPR spectroscopy, that NO is not generated during spontaneous decay of streptozotocin but that its metabolization in rat hepatocytes and pancreatic islet cells yields NO. This NO formation is not due to a NO synthase (NOS) activity since NO formation in hepatocytes in the presence of streptozotocin is not blocked by the NOS inhibitor NG-methyl-L-arginine. By iNOS-specific RT-PCR no positive signal for specific mRNA presence was obtained in streptozotocin-treated cells, proving that iNOS activity was not induced during cell isolation procedures and did not account for the NO release. Furthermore, early DNA-strand breaks induced either by SZ or by the NO donor nitroprusside were both significantly reduced in the presence of an intracellular NO scavenger. In contrast, DNA damage found after incubation with the purely alkylating agent methylmethanesulfonate was not inhibited by the NO trap. These results prove that intracellular formation of NO occurs during degradation of SZ within cells. This NO appears to contribute significantly to streptozotocin-induced cytotoxicity.

Alkylating Agents↗

PubMed1995

[Determination of the energy density of rapid periodic laser light patterns of homogeneous superficial coverage for medical applications].

The use of laser light in in vitro experiments on fibroblasts and osteoblasts and animal experiments has revealed similar thresholds the crossing of which is apparently necessary for achieving photobiological effects. Clinical observations suggested that such a threshold might apply to energy density, while further investigations seemed to indicate that a threshold for intensity (power density) might also be of importance. This was investigated in the clinical setting involving laser light applications to large areas. Initial measurements obtained with available measuring equipment pointed up the problems associated with the measurement of power and energy in different-speed radiation systems. Using a laser in conjunction with a "light chopper", a way of determining the range of a measuring system, in which useful measurements can be obtained is described.

Animals↗

PubMed1995

Impact of vitamin A supplementation on prevalence and incidence of xerophthalmia in Nepal.

PURPOSE: To assess the impact of vitamin A supplementation at 4-month intervals on the prevalence and incidence of xerophthalmia among preschool-age children. METHODS: A stratified, random sample of 40 wards with 4766 children in Sarlahi district of Nepal was selected to participate in a randomized, controlled, community trial. In the vitamin A group, at 4-month intervals, neonates received 50,000 IU, 1- to 11-month-old infants received 100,000 IU, and children 1 through 4 years of age received 200,000 IU. Children underwent eye examination before the intervention and 16 months later. RESULTS: Before the intervention, 4318 children were examined for xerophthalmia. The prevalence was 2.3% in the vitamin A group and 3.3% in the placebo group. All children with xerophthalmia were treated with vitamin A at the time of the examination. Of those examined at baseline, 38 in the vitamin A group and 48 in the placebo group died in the 16 months after intervention. There were 1871 (84%) surviving children in the vitamin A group and 1711 (85%) in the placebo group examined at follow-up. After adjustment for the baseline prevalence of xerophthalmia, vitamin A reduced the prevalence at follow-up by 63% (95% confidence interval, 21% to 83%). The apparent incidence was 3.2/1000 per year in the vitamin A group and 9.2/1000 per year in the placebo group, an adjusted reduction of 62% (95% confidence interval, 0% to 86%). CONCLUSIONS: Supplementation was effective at reducing the prevalence and incidence of xerophthalmia.

Child, Preschool↗

PubMed1995

Repeatability of the Glaucoma Hemifield Test in automated perimetry.

PURPOSE: To examine the concordance of the Glaucoma Hemifield Test and other global visual field indexes between two consecutive automated visual field tests. METHODS: Normal subjects, subjects with ocular hypertension, and subjects with glaucoma had two automated visual field tests on the Humphrey Field Analyzer. The Glaucoma Hemifield Test results, mean deviation, and corrected pattern standard deviation of the two consecutive visual field tests were compared. RESULTS: Forty-one normal subjects were tested within 1 and 2 years of each other. Four hundred seven subjects with ocular hypertension and 95 subjects with glaucoma were tested 1 year apart. The proportion of normal subjects who met a criterion for abnormality on two consecutive tests was 2.4%. The proportion of subjects with glaucoma with normal results of two tests was 10.5%. The specificity of automated visual field testing was improved from 80.8% to 89.9%, with a modest loss of sensitivity if two rather than one abnormal test result was required for entry into a clinical trial enrolling patients with glaucomatous field loss. Similarly, specificity increased from 84.2% to 89.5% if two normal tests were required for entry into an ocular hypertensive clinical trial. Among subjects with more closely spaced tests, the agreement between consecutive tests was similar for tests spaced 4 versus 12 months apart. CONCLUSIONS: Although there is concordance of Glaucoma hemifield Test results on consecutive testing, there is enough disagreement to result in improved specificity from the use of a second test in a clinical trial setting.

Adult↗

PubMed1995

Transfer of phospholipase A-resistant pyrene-dialkyl-glycerophosphocholine to plasma lipoproteins: differences between Lp[a] and LDL.

1-O-Hexadecyl-2-O-pyrenedecanyl-sn-glycero-3-phosphocholine, a non-hydrolyzable fluorescent diether analog of phosphatidylcholine (PC), was synthesized as a probe for studying phospholipid transfer to different lipoprotein classes with potential phospholipase activities. After incubation of total human plasma with the new probe at 37 degrees C for 4.5 h, a characteristic partition between the main lipoprotein fractions was observed. The fluorescent lipid was not degraded under these conditions and, therefore, served as a measure for choline glycerophospholipid distribution between plasma lipoproteins. In low density lipoprotein (LDL) and high density lipoprotein-3 (HDL3) the fluorescent PC analog showed only monomer fluorescence, whereas in Lp[a] and HDL2 monomer and excimer fluorescence were observed, indicating that the fluorescent phosphatidylcholine analog was incorporated into the respective lipoproteins to a different extent. According to the increased pyrene excimer fluorescence in Lp[a] compared with LDL the labeled phosphatidylcholine must be enriched and/or clustered in Lp[a]. Data from phospholipid and total fluorescence analyses are compatible with the assumption of higher label concentration in Lp[a]. On the other hand, transfer rates for serum protein-catalyzed lipid transport into isolated Lp[a] were slower as compared to LDL. It is suggested that slower lipid transfer to Lp[a] under these conditions is due to the decreased lipid mobility in the Lp[a] surface, whereas the higher extent of label partition into Lp[a] as observed in total plasma might be due to the higher affinity of apolipoproteins for phosphatidylcholine in Lp[a] (Sommer, A., et al. 1992. J. Biol. Chem. 267: 24217-24222). The use of a fluorescent dialkyl- instead of diacyl-glycerophosphocholine for transfer studies was mandatory, as we found that lipoproteins contained phospholipase A2 activity toward long-chain phosphatidylcholine. The lipoprotein-associated phospholipase A2 was three times more active in Lp[a] than in LDL. The degradation products formed by the phospholipase, fatty acids, and lyso-PC may add to the high atherogenic potential of Lp[a].

Biological Transport↗

PubMed1995

[Mineral metabolism in young beef cattle during the period of changing from winter feed rations to grazing].

Concentrations of calcium, inorganic phosphorus, magnesium, sodium and potassium were observed in the blood serum of beef bullocks after their transfer from winter feed ration to grazing and in the successive grazing cycles within two years. Blood samples were taken by puncture from the vena jugularis from the identical six bullocks. In the first year of observation, blood collection took place a week before transfer to grazing while in the second year of observation twice in weekly intervals before grazing. In the period of grazing, the biological material was sampled in weekly intervals from week 1 to week 5 (May--Ist cycle, June--IInd cycle), then in week 10 (July--IIIrd cycle) and in week 14 (August--IVth cycle of grazing). Calcium concentrations in the blood serum of beef bullocks (Fig. 1) decreased after transfer from stable feeding to grazing while this drop was significant in the second year of observation (P < 0.05). That period was followed by an increase in serum calcium concentrations in both target groups. The concentrations of inorganic phosphorus in the serum of beef bullocks (Fig. 2) dropped after transfer to grazing but a gradual increase in the values was recorded in week 4 in the first year of observation and in week 5 of grazing in the 2nd year of observation. These changes were not statistically significant. The concentrations of serum magnesium in beef bullocks (Fig. 3) statistically significantly dropped (P < 0.05) after transfer from stable feeding to grazing in week 3 in the first year of observation and in week 4 of grazing in the second year of observation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗

PubMed1995

Treatment of esophageal fistulas with a new polyurethane-covered, self-expanding mesh stent: a prospective study.

OBJECTIVES: Esophagorespiratory fistulas are serious complications of malignant disease in the esophagus and are associated with rapid deterioration and death. Palliation has thus far consisted of insertion of a plastic stent to occlude the fistula opening. Insertion of these stents is associated with a high complication rate. Our aims were to study the efficacy of a new class of metal stents covered with a membrane with regard to fistula occlusion and lumen patency. METHODS: Six consecutive patients with esophagorespiratory fistulas were treated with covered expandable metal stents. RESULTS: In all six patients, no evidence of persisting fistula was seen on contrast radiographs 2 h after stent placement. All patients were able to eat a normal diet after stent insertion and had complete occlusion of their esophagorespiratory fistula. One patient reported pain after the procedure, and the symptoms persisted until death. One patient died of massive hematemesis 5 days after the procedure. Dysphagia scores improved in all patients from a median of 4 to a median of 1, and the Karnofsky score improved from a median of 40% to a median of 65%. Fistulas remained closed until death in all patients. CONCLUSIONS: Covered expandable metal stents are safe and effective in the palliation of esophagorespiratory fistulas.

Aged↗