Safety and efficacy of endoscopic vacuum therapy for the treatment of perforations and anastomotic leaks of the upper gastrointestinal tract. / Eficacia y seguridad de la terapia de vacío endoscópica para el tratamiento de perforaciones y dehiscencias anastomóticas del tracto digestivo superior.

AIM: To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS: This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS: 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION: EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated.

Gastrointestinal Physiological Changes and Their Relationship to Weight Loss Following the POSE Procedure.

BACKGROUND: Primary Obesity Surgery Endolumenal (POSE) is a novel bariatric endoscopic procedure that has been shown to reduce weight safely through 12 months. The study investigated potential mechanisms of weight loss following POSE. METHODS: Patients with class I-II obesity received transmural plications in the gastric fundus and distal gastric body. Patients were evaluated at baseline and at 2- and 6-month follow-up with gastric-emptying (GE) scintigraphy, a validated test of intake capacity (kcal) and plasma glucose homeostasis hormones/gastrointestinal peptides. Weight was recorded through 15 months. Mean data and 95% CIs are reported. Regression modeling assessed variables that influenced total weight loss (%TWL) and excess weight loss (%EWL). RESULTS: POSE was performed on 18 patients (14 F/4 M); mean age 39 years (34-44), body mass index (BMI, kg/m(2)) 36 (95% CI, 35; 37). At 15 months (n = 15), mean TWL was 19.1 ± 6.6% (15.5; 22.8) and EWL was 63.7 ± 25.1% (49.8; 77.6). At 2 and 6 months (n = 18), intake capacity decreased significantly from 901 (685; 1117) to 473 (345; 600) and 574 kcal (418; 730), respectively (p < 0.001). At 2 months, GE was delayed but returned to baseline levels at 6 months (n = 18). Glucose/insulin ratio improved (p < 0.05). Postprandial decrease in ghrelin was enhanced (p = 0.03) as well as postprandial increase in PYY (p = 0.001). The best model for EWL prediction 15 months after POSE (R (2): 66%, p = 0.006) included pre-POSE BMI, post-POSE GE, and postprandial PYY increase. CONCLUSIONS: The POSE procedure was followed by significant sustained weight loss and improved glucose homeostasis and satiation peptide responses. Weight loss following POSE may be mediated through changes in gastrointestinal neuro-endocrine physiology.

Acute pneumonitis presumed to be silicone embolism.

A 39-year-old housewife who underwent intramammary injections of a proprietary silicone fluid mixture showed clinical and novel transbronchial lung biopsy (TBLB) findings. She presented with complaints of progressive dyspnea, dry cough, and pleuritic chest pain 2 days after the last silicone injections. The chest X-ray and CT scan showed diffuse interstitial infiltrates. TBLB demonstrated translucent, presumably silicone globules embolized within the pulmonary capillaries. The documentation of intramammary injections, the clinical and radiographic features of acute pneumonitis, and the histopathologic evidence by TBLB, may support the causal relationship between illicit injections and the silicone embolism. We discuss the pathogenesis and urge that this potentially toxic source of pulmonary embolism be removed.

A hepatobiliary study with Tc-99m N-pyridoxyl-5-methyltryptophan (PMT) in a patient with hepatoblastoma.

A patient with hepatoblastoma in whom a hepatobiliary study with Tc-99m PMT demonstrated homogeneous uptake in the tumor is presented. Sonography showed a large solid mass pedunculated from the right hepatic lobe with a "tumor-in-tumor" pattern. It was hypodense relative to normal hepatic parenchyma on CT scanning without contrast material and turned isodense with contrast material. This represented its hypervascularity, which was confirmed by selective celiac arteriography.

Immunohistochemical studies of ulcerative colitis. With special reference to localization of immunoglobulins, secretory component, and lysozyme in view of suffering periods.

Surgically resected large bowels with ulcerative colitis (UC) and biopsies specimens from UC patients were studied immunohistochemically in terms of localization of immunoglobulins, secretory component (SC), complement (C3), and lysozyme in relation to suffering periods. In the long-standing group (suffering periods more than nine months) of UC, marked decrease or absence of IgA as well as IgM was frequently observed in the columnar epithelial cells despite residue of SC positivity. However, in the short-standing group (suffering periods from one month to four months) both SC and IgA were well preserved in the apical portion of the epithelial cells in the similar manner as observed in the control group. There was moderate to marked increase of IgA-producing cells and slight to moderate increase of IgM-producing cells in the majority of the UC cases regardless of suffering periods. Lysozyme was not demonstrable in the normal epithelial cells of the large intestine but occasionally observed in those of UC cases.

Histopathological and morphometrical study of the human epididymis and testis.

Histopathological and morphometrical observations of the epididymis and testis were performed on 159 autopsy cases and 3 surgical materials of orchiectomy. The serum values of testosterone, FSH, LH, and values of intratesticular testosterone were measured in a certain number of the cases. Concerning the epididymis, increasing arteriosclerotic change was observed in the older epididymis. A high incidence of hyalinization of small arteries and arterioles was found in the younger epididymis. Eosinophilic microbodies were seen in the epithelial nuclei of the ductus epididymidis with high incidence in the older age groups. They were thought to be a catabolic compound containing phospholipids and protein resulting from cell degeneration of the mucosal epithelium. The diameter of the ductus epididymidis decreased with age. Inflammatory changes and ensued periductal sclerosis were found in the efferent duct area with an extremely high incidence. Serum values of testosterone correlated with both the age and morphological scoring calculated on the basis of either clusters or individual Leydig cells. Furthermore, testicular volume was inversely correlated with age.