[Management of postoperative ischemic jejunal stenosis using balloon dilatation and/or Wallstent implant]. / Postoperativ ischaemiás jejunalis stenosis kezelése ballonkatéteres tágítással vagy/és Wallstent implantatióval.

Ischaemic stenosis of the jejunum is rare. For technical, anatomical, and pathological reasons ischemic stenosis of the jejunal segment used for the replacement of the stomach and oesophagus requires a special approach. The present study reports two cases of dilation of ischaemic strictures of the jejunal loop by balloon catheter, used for replacement after oesophagogastrectomy and gastrectomy. In the later case, in which the occlusion of the blood vessels supplying the affected segment was observed right at the level of the aorta, Wallstent was implanted. The advantages and disadvantages of metal stents are discussed and oesophaogoaortic fistula, a rare complication, which appeared a year after Wallstent placement, is described. The two cases presented in this study give evidence that using balloon catheters and implanting Wallstent-in selected cases-may give good results in the management of postoperative ischaemic strictures of the jejunum. The minimally invasive technique with the special indications described here is not known to have been used so far. The rare complication mentioned, however, requires special attention.

[Management of extensive, potentially fatal, pulmonary embolism]. / Klinikai halálhoz vezetö nagy kiterjedésü tüdöembóliák kezelése.

Extensive pulmonary embolisms were suspected in 11 patients with severe cardiogenic shock admitted to an intensive care unit. The urgently established diagnosis was always based on clinical symptoms and on a complex criteria system elaborated by the authors. The "blind" diagnosis of subtotal pulmonary embolism was confirmed by further noninvasive examinations in 10 cases. During the measures of complex resuscitation, the authors administered high doses of streptokinase in 10 cases and ultra-high dose of streptokinase for one patient. The emergency treatment was successful in four cases.

[Treatment possibilities for extensive pulmonary embolism as an alternative to the Trendelenburg operation]. / Nagy kiterjedésü tüdöembóliák kezelési lehetöségei, mint a Trendelenburg-mütét alternatívái.

The authors describe the clinical course of successfully treated patients with extensive, subtotal pulmonary embolism. After the diagnosis was confirmed by isotopic scan or pulmonary angiography, mechanical thrombus destruction was applied followed by low dose loco-regional thrombolysis in 11 patients by streptokinase. Five patients were treated with ultrahigh dose of streptokinase through peripheral vein, one patient via pulmonary artery catheter and one patient was treated with high dose urokinase by pulmonary catheter in combination with mechanical thrombus destruction by guide wire. All the treatment procedures were proved to be successful. After detailed case reports, the authors review the life saving thrombolytic treatment of acute subtotal pulmonary embolism as an alternative of Trendelenburg operation.

[Lifesaving thrombolysis--in the light of contraindications]. / Eletmentö thrombolysis--a kontraindikációk tükrében.

The authors review the different methodological suggestions concerning thrombolysis, especially from the aspects of the absolute and relative contraindications of the treatment. They present case reports to prove that in patients with life threatening thromboembolic diseases some points of contraindications may be disregarded. They suggest a new strategy of absolute and relative contraindications be made considering the currently available recently introduced thrombolytic therapy.

Postoperative ischemic jejunal stenosis treated with balloon catheter dilation and Wallstent implantation.

Ischemic stenosis of the jejunum is rare. For technical, anatomical, and pathological reasons, ischemic stenosis of the jejunal segment used for the replacement of the esophagus or the stomach, or both, represents a special entity. The present study reports a case of balloon catheter dilation of ischemic strictures of the jejunal segment, used for substitution after gastrectomy. In this patient, an occlusion of the blood vessels supplying the affected segment was observed at its aortic origin, and a Wallstent was implanted. A rare late complication, aortoesophageal fistula, appeared one year after placement of the Wallstent. The case presented in this study suggests that using balloon catheters and implanting a Wallstent may be a useful approach to the management of postoperative ischemic strictures of the jejunum in selected cases. The minimally invasive technique with special indications used here has not previously been described. The rare complication mentioned, however, requires special attention.