Transesophageal access to the cardiac cavities and descending thoracic aorta via echoendoscopy. An experimental study.

OBJECTIVE: The applications of endoscopic ultrasonography have diversified over recent years. The possibility of reaching cardiac territory has been successfully explored in experimental models, opening up a new field of possibilities for diagnostic and therapeutic interventions that were unthinkable until very recently. The aims set out in this study are to evaluate cardiac anatomy, its approach, the safety of the experimental procedure and the resulting morphological and histological changes after the procedure. MATERIAL AND METHODS: The study has been performed on two adult pigs. They have undergone different surgical approaches to the cardiac cavities and descending thoracic aorta with excellent results. RESULTS: Different cardiac structures have been identified and operated upon (right auricle, left auricle, left ventricle, cardiac valves), as well as major vessels. The use of contrast, both intracavitary and from a peripheral vein, enabled us to verify the anatomical spaces studied. During the procedures we monitored for arrhythmias, hemodynamic behavior, possibility of infection by obtaining sample hemocultures before and after procedures, and response to punctures. CONCLUSIONS: The present study has enabled us to evaluate access to the heart from the esophageal lumen using endoscopic ultrasonography, with results that are very similar to those described in the current bibliography. However, we offer two novelties: puncture of the right auricle through the interauricular partition and puncture of the descending thoracic aorta, both performed with ease and apparent safety.

[Clinical presentation, diagnosis, and long-term outcome of 29 patients with Wilson's disease]. / Presentación clínica, diagnóstico y evolución a largo plazo en 29 pacientes con enfermedad de Wilson.

OBJECTIVE: To analyze the clinical characteristics, treatment, and follow-up of a cohort of 29 patients with Wilson's disease (WD) within the region of Murcia. PATIENTS AND METHOD: We reviewed the medical records of 29 cases of WD (mean age, 20.3 +/- 13.4 years) diagnosed during the last 16 years. RESULTS: The most frequent reason for consultation was upon discovering a high transaminase level in almost half the patients, followed by tremors or dystonia in 17% of patients, respectively. A Kayser-Fleischer ring was observed in 17/29 (58.6%) of patients (100% of patients with pure neurological involvement and 35% of patients with pure clinical hepatic disease; p < 0.001). Blood copper levels not associated with ceruloplasmin as well as cupruria were notably superior in patients with neurological symptoms and in those with liver cirrhosis at the time of diagnosis. Patient clinical symptoms remained stable with D-penicillamine or trientine, or improved during the observation period, for 18 out of 29 patients (62%), while 11 out of 29 patients (38%) got worse. CONCLUSIONS: In our region patients with WD are diagnosed at a younger age, and in most cases for hepatic disease. Patients with neurological disease or liver cirrhosis had a high level of free copper not associated to ceruloplasmin and cupruria. The disease had a favorable evolution in all patients but those diagnosed with hepatic disease or advanced neurological disease.

[Macroamylasemia: its current and clinical importance]. / Macroamilasemia: actualización e importancia clínica.

The understanding of the causes for hyperamylasemia is of great importance when focusing on the differential diagnosis of acute pancreatitis. Among the causes for hyperamylasemia, special interest is given to macroamylasemia not only because it is poorly understood, but also because we are lacking national studies. In this disorder, the amyl binds to another serum substance, varying from one patient to another, and forms a macromolecular complex. The biochemical characteristics of clinical interest as well as its prevalence are discussed. Its etiopathogenesis and clinical implications are unknown, requiring different methods for its detection that will give better efficacy and reproducibility.

[Acute pancreatitis associated with duodenal immunoblastic sarcoma and upper digestive hemorrhage]. / Pancreatitis aguda asociada a sarcoma inmunoblástico duodenal y hemorragia digestiva alta.

We present a patient with acute pancreatitis that was specially persistent from a biochemical viewpoint, derived from a duodenal sarcomatous tumor of immunoblastic type that narrowed the second duodenal segment for a length of about 8 centimeters. We discuss the possible role of tumoral neoformations in the production of pancreatitis due to increased intraluminal pressure distal to the Vater ampulla, or to occlusion of the Oddi sphincter or the Wirsung duct. We review the existent literature.

Acceso transesofágico a cavidades cardiacas y aorta torácica descendente mediante ecoendoscopia. Estudio experimental / Transesophageal access to the cardiac cavities and descending thoracic aorta via echoendoscopy. An experimental study

Objetivo: las aplicaciones de la ultrasonografía endoscópicase han diversificado en los últimos tiempos. La posibilidad de accederal territorio cardiaco se ha explorado en modelos experimentalescon buenos resultados, abriendo un campo de nuevasposibilidades de intervencionismo diagnóstico y terapéutico hastahace poco impensables. Los objetivos planteados en este trabajopretenden evaluar la anatomía cardiaca, su abordaje, la seguridaddel procedimiento experimental y los cambios morfológicos e histológicosderivados.Material y métodos: se ha trabajado con dos animales adultosde la especie porcina a los que se han practicado diversosabordajes a cavidades cardiacas y aorta torácica descendente conexcelentes resultados.Resultados: se han identificado y abordado diversas estructurascardiacas (aurícula derecha, aurícula izquierda, ventrículo izquierdo,válvulas cardiacas) y grandes vasos. El uso de contrasteintracavitario y desde una vía venosa periférica ha permitido asegurarlos espacios anatómicos estudiados. Durante los procedimientosse ha monitorizado la aparición de arritmias, el comportamientohemodinámico, la posibilidad de infección mediante laobtención de hemocultivos antes y después de aquellos y la respuestaa las punciones.Conclusiones: el presente trabajo nos ha permitido evaluar elacceso al corazón desde la luz esofágica mediante ultrasonografíaendoscópica, con unos resultados muy similares a los observadosen la literatura, ofreciendo dos novedades como la punción de laaurícula derecha a través del tabique interauricular y de la aorta torácicadescendente, de forma fácil y aparentemente segura(AU)

Objective: the applications of endoscopic ultrasonographyhave diversified over recent years. The possibility of reachingcardiac territory has been successfully explored in experimentalmodels, opening up a new field of possibilities for diagnostic andtherapeutic interventions that were unthinkable until very recently.The aims set out in this study are to evaluate cardiacanatomy, its approach, the safety of the experimental procedureand the resulting morphological and histological changes afterthe procedure.Material and methods: the study has been performed ontwo adult pigs. They have undergone different surgical approachesto the cardiac cavities and descending thoracic aorta with excellentresults.Results: different cardiac structures have been identified andoperated upon (right auricle, left auricle, left ventricle, cardiacvalves), as well as major vessels. The use of contrast, both intracavitaryand from a peripheral vein, enabled us to verify theanatomical spaces studied. During the procedures we monitoredfor arrhythmias, hemodynamic behavior, possibility of infection byobtaining sample hemocultures before and after procedures, andresponse to punctures.Conclusions: the present study has enabled us to evaluate accessto the heart from the esophageal lumen using endoscopic ultrasonography,with results that are very similar to those describedin the current bibliography. However, we offer two novelties:puncture of the right auricle through the interauricular partitionand puncture of the descending thoracic aorta, both performedwith ease and apparent safety(AU)