PURPOSE: To evaluate initial results in patients with epiphora secondary to obstruction of the nasolacrimal duct treated by placement of a polyurethane stent, and to discuss the technical problems and complications arising during the procedure, with visualization of the anatomy of the drainage apparatus using computed tomography (CT). METHODS: We inserted 20 polyurethane Song stents under fluoroscopic guidance after dacryocystography in 19 patients with grade 3-4 epiphora caused by idiopathic obstruction of the nasolacrimal duct. CT scans were obtained following stent placement in all patients. RESULTS: We focus on the technical problems and complications that arose during these procedures. During negotiation of the guidewire past the obstruction at the level of the junction of the duct with the lacrimal sac, the guidewire created a false passage in a posterior suborbital direction in two cases and towards the posterior midline in another. In all cases the guidewire was withdrawn and reinserted through the proper anatomic route without further difficulty or complications. In two cases the stent was improperly positioned wholly or partially outside the nasolacrimal system (one medially, one posteriorly). In one case the stent was removed and reinserted; in the other it remains in place and functional. CT was performed in all these cases to ensure proper anatomic alignment and determine what had gone wrong. The epiphora was completely resolved in 13 cases and partially relieved in four; there were three cases of stent obstruction. Epistaxis of short duration (1 hr) occurred in seven patients and headache in one. CONCLUSIONS: Treatment of epiphora with polyurethane stents is a technique that is well tolerated by patients and achieves a high success rate, yet problems in placement may be encountered. Though no major consequences for patients are involved, cognizance of such difficulties is important to avoid incorrect positioning of stents.

Adult↗

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Marching on with managed care.

In a matter of months, officials with Tricare--the military's answer to managed care--hope to have the operations and information systems in Region 1 up and running. Military officials plan to increase the use of technology in this region by connecting military healthcare facilities not only with each other, but eventually with civilian managed care organizations. Tricare administrators could be creating an ideal role model for the integration needs within the civilian sector.

Delivery of Health Care, Integrated↗

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Outcomes needs bring innovations to home care.

Explore the source record for details and available documents.

Home Care Services↗

PubMedDate not supplied

Self-expanding prostheses as a palliative method in treating advanced colorectal cancer.

AIM: This work presents the results of the use of self-expanding prosthesis as a definitive palliative method for eliminating colorectal obstructions caused by advanced and unresectable tumours. PATIENTS: A total of 41 cases were included (29 men, 12 women) with an average age of 70.12 years (range 46-95 years). All cases were showed symptoms of acute intestinal obstruction. Wallstent prostheses were inserted. RESULTS: Locally unresectable colorectal tumours were disseminated in five cases, metastasis in 28 cases and other tumours in eight cases. In all patients the appropriate insertion was performed, eliminating the obstruction in 38 (92.6%) cases in 24-96 h. The morbidity rate was 6/41 cases (14.6%) with slight rectal discomfort in five and one case of bleeding. Posterior tolerance of the prostheses was good. FOLLOW-UP: Two spontaneous rejections, three episodes of subocclusion because of faecal impact and two obstructions caused by an invasion of tumours occurred. Overall, 33 cases (80.4%) died within 1-18 months, average of 4.5 months survival. CONCLUSIONS: Wallstent endoprostheses is a good alternative avoiding a colostomy and providing a good tolerance and comfort for the patient until death.

Aged↗