Dialysis-associated steal syndrome as a rare complication of arteriovenous fistula angioplasty.

The angioplasty of arteriovenous fistulas (AVF) has become indispensable in preserving haemodialysis access. Though well-known complications, such as pseudoaneurysm formation and rupture, can occur, the incidence of severe dialysis-associated steal syndrome (DASS) following AVF angioplasty is low. We describe a patient with limited dialysis options who developed significant DASS following angioplasty of his AVF. After excluding flow-limiting causes of DASS, the patient underwent a successful Revision Using Distal Inflow procedure, redirecting blood flow to his distal arm. Subsequently, all ischaemic symptoms resolved. While effective surgical options are available for the management of DASS, preventive measures such as proper angioplasty balloon sizing remain key.

Total Percutaneous Access for Deployment of a Custom Made Fenestrated Stent Graft in a 90 Year Old with a Large Symptomatic Thoracic Aortic Aneurysm.

INTRODUCTION: Open surgical cut down has been the standard for gaining carotid access in most thoracic endovascular repairs of aortic aneurysm (TEVAR) cases; however, when suitable, total percutaneous repair can be beneficial. REPORT: A relatively fit 90 year old man with few medical comorbidities presented with six months of worsening upper back pain and an Ishimaru zone 2 fusiform thoracic aortic aneurysm of 7.2 cm diagnosed on CT aortography. A total percutaneously inserted custom made device (CMD) with innominate artery (IA) scallop, left common carotid artery (LCCA) fenestration combined with left subclavian artery (LSA) occlusion provided an effective repair. Haemostasis was obtained with Abbott Perclose ProGlide suture-mediated devices. The patient was discharged on post-operative day two. Follow up CT at one month was unremarkable without any endoleak, and an improvement in symptoms. DISCUSSION: There are risks of cerebral ischaemia and other complications with open carotid cut down, hence it is worth considering avoiding if possible, especially for select patients. Retrograde carotid access and subsequent closure device deployment is not new, but in conjunction with CMD, TEVAR allowing for carotid stenting is feasible and less often described in the literature.

Critical analysis of mucin and signet ring cell as prognostic factors in an Asian population of 2,764 sporadic colorectal cancers.

INTRODUCTION: Conflicting data on the clinicopathological characteristics as well as prognosis and survival of signet ring cell (SRC) and mucinous adenocarcinomas (MA) of the colorectum persist. METHODS: Consecutive patients (2,764) with sporadic colorectal cancer from 1999 to 2005 were evaluated. The clinicopathological characteristics of these patients were reviewed. Univariate analysis was performed, and survival curves were constructed using the Kaplan-Meier method. Multivariate analysis assessed independent prognostic factors. RESULTS: The incidence of MA and SRC is 6% and 1.1%, respectively. MA and SRC tend to occur in patients aged

Colorectal cancer screening: the effectiveness of education on its barriers and acceptability.

To assess the awareness and acceptability of colorectal cancer (CRC) screening in noncompliant Singaporeans and to determine if their barriers can be overcome by education. A questionnaire developed from thematic analysis of open-ended interviews with 72 subjects was administered to 580 residents in a local high-rise housing estate. Participants aware of CRC screening were assessed for barriers and acceptability of CRC screening. All participants were subsequently educated about CRC screening and reassessed for barriers and acceptance. Those keen for fecal occult blood testing (FOBT) were offered FOBT kits and followed up. CRC screening awareness was poor. Having no symptoms was the most common barrier. More barriers to FOBT than to colonoscopy were reduced with education. After education, acceptability toward FOBT increased but rejection rates rose even higher. FOBT is probably Singapore's most acceptable screening modality. Education is limited by barriers, which need to be overcome by alternative measures.