RESUMEN
OBJETIVO: Evaluar la eficacia y seguridad de la terapia de vacío endoscópica (TVE) en perforaciones y dehiscencias del tracto digestivo superior. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional donde se incluyeron todos los pacientes que presentaron algún defecto del tracto gastrointestinal superior y que fueron sometidos a TVE en el período comprendido entre abril de 2017 y febrero de 2019 en 3 centros españoles. Para ello se utilizó el único sistema de terapia de vacío aprobado para uso endoscópico hasta la fecha (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Alemania). RESULTADOS: Un total de 11 pacientes fueron sometidos a TVE como tratamiento de una dehiscencia de sutura anastomótica tras esofaguectomía (n=7), gastrectomía (n=2), como tratamiento de una perforación esofágica tras septomiotomía endoscópica de Zenker (n=1) y tras una perforación esofágica espontánea o síndrome de Boerhaave (n=1). La mediana del tamaño de la cavidad fue de 8×3cm. De mediana, la TVE se inició a los 7días de la cirugía inicial. La mediana de duración de la TVE fue de 28días. La mediana de esponjas colocadas fue de 7 y el intervalo de recambio de las esponjas, de 3,7días. En 10 casos (91%) se consiguió el cierre del defecto y en 9 casos (82%) la resolución clínica del cuadro infeccioso asociado. Cinco pacientes presentaron algún evento adverso: 3 estenosis anastomóticas, un episodio de dolor retrofaríngeo y un caso de neumonía de nueva aparición. La mediana de estancia hospitalaria desde el inicio de la TVE fue de 45días. Un paciente falleció debido a complicaciones sépticas secundarias a la dehiscencia de sutura. CONCLUSIÓN: La TVE tiene una eficacia superior al 90% en las perforaciones y fugas anastomóticas del tracto digestivo superior. Adicionalmente es una terapia segura, siendo los eventos adversos leves
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
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Dehiscencia de la Herida Operatoria/terapia , Endoscopía del Sistema Digestivo/métodos , Resultado del Tratamiento , Perforación Intestinal/cirugía , Estudios Retrospectivos , Perforación Intestinal/diagnóstico , Fístula del Sistema Digestivo/cirugía , Fuga AnastomóticaRESUMEN
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.
Asunto(s)
Fuga Anastomótica/cirugía , Enfermedades Duodenales/cirugía , Endoscopía Gastrointestinal , Perforación del Esófago/cirugía , Perforación Intestinal/cirugía , Terapia de Presión Negativa para Heridas/métodos , Rotura Gástrica/cirugía , Tracto Gastrointestinal Superior/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/efectos adversos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Cirugía Bariátrica/métodos , Obesidad/cirugía , Estómago/cirugía , Pérdida de Peso/fisiología , Adulto , Regulación del Apetito/fisiología , Glucemia/análisis , Ingestión de Energía/fisiología , Femenino , Vaciamiento Gástrico/fisiología , Fundus Gástrico/cirugía , Gastroscopía/métodos , Homeostasis , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatología , Péptidos/análisis , Periodo Posprandial , Estómago/fisiopatología , Adulto JovenRESUMEN
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.
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Implantes de Mama/efectos adversos , Enfermedades Pulmonares Intersticiales/etiología , Embolia Pulmonar/etiología , Siliconas/efectos adversos , Enfermedad Aguda , Adulto , Femenino , Humanos , Pulmón/patología , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/patología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/patología , RadiografíaRESUMEN
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.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Hígado/diagnóstico por imagen , Compuestos de Organotecnecio , Triptófano/análogos & derivados , Angiografía , Carcinoma Hepatocelular/irrigación sanguínea , Preescolar , Humanos , Neoplasias Hepáticas/irrigación sanguínea , Masculino , Cintigrafía , Tomografía Computarizada por Rayos XRESUMEN
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.
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Epidídimo/patología , Testículo/patología , Adulto , Anciano , Envejecimiento , Autopsia , Castración , Epidídimo/crecimiento & desarrollo , Epidídimo/ultraestructura , Hormona Folículo Estimulante/sangre , Humanos , Células Intersticiales del Testículo/citología , Hormona Luteinizante/sangre , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Testículo/crecimiento & desarrollo , Testículo/ultraestructura , Testosterona/análisis , Testosterona/sangreRESUMEN
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.