Esophageal perforation secondary to an arterial embolization device in scimitar syndrome.

Scimitar syndrome is a congenital malformation that is usually associated with hypoplasia of the right lung with an abnormal blood supply by direct branches of the aorta. These branches normally require embolization.

Authors' response to "Straight plastic stents in tumors at the hepatic hilum and related duodenal perforation".

We appreciate the interesting comments from García Cano et al. regarding the complications derived from the use of plastic prostheses in hilar tumors. Indeed, most of the published case reports on duodenal perforations secondary to migrated biliary prostheses occurred with plastic stents, which may be related to the entrapment phenomenon described.

Endoscopic management of a duodenal perforation secondary to a migrated biliary plastic stent.

The migration of plastic biliary prostheses occurs in up to 14 % of patients undergoing biliary stenting. Duodenal perforation is a rare but very serious complication. A delay in diagnosis complicates management and worsens prognosis.

Experiencia inicial con elastografía en tiempo real mediante ecobroncoscopio en la evaluación de ganglios linfáticos mediastínicos / Initial Experience With Real-Time Elastography Using an Ultrasound Bronchoscope for the Evaluation of Mediastinal Lymph Nodes

La elastografía en tiempo real realizada durante la ultrasonografía endoscópica digestiva es una técnica relativamente nueva que permite caracterizar la dureza de los tejidos, y ha sido utilizada con éxito como predictor de malignidad en ganglios mediastínicos. En la presente nota clínica se describe nuestra experiencia práctica en la técnica de la elastografía con ecobroncoscopio en el estudio de los ganglios linfáticos mediastínicos. Presentamos un caso realizado mediante ultrasonografía endobronquial sectorial y el primer caso publicado de elastografía por ultrasonografía endoscópica con ecobroncoscopio, en 2 pacientes con carcinoma de pulmón no microcítico. El patrón cualitativo en color del tejido se obtuvo en ambos casos y se correlacionó con la evaluación anatomopatológica. Los resultados de viabilidad iniciales son prometedores y las aplicaciones ecobroncoscópicas, como la estadificación ganglionar guiada, requieren ser evaluadas. Categorizar el riesgo de malignidad puede ser importante para ayudar a tomar decisiones en la obtención de muestras

Real-time elastography performed during endoscopic ultrasonography is a relatively new method for characterizing tissue stiffness, and has been used successfully as a predictor of malignancy in mediastinal lymph nodes. This case report describes our practical experience with this technique using an ultrasound bronchoscope to examine mediastinal lymph nodes. We present a case of sectorial endobronchial ultrasound and the first published case of endoscopic ultrasound elastography using ultrasound bronchoscope in two patients with non-small cell lung carcinoma. Qualitative tissue color pattern was obtained in both cases and correlated with pathological evaluation. The initial feasibility results are promising and suggest that ultrasound bronchoscopy techniques, such s guided nodal staging, merit additional studies. It may be importantto categorize the risk of malignancy to facilitate sampling decisions

Initial experience with real-time elastography using an ultrasound bronchoscope for the evaluation of mediastinal lymph nodes.

Real-time elastography performed during endoscopic ultrasonography is a relatively new method for characterizing tissue stiffness, and has been used successfully as a predictor of malignancy in mediastinal lymph nodes. This case report describes our practical experience with this technique using an ultrasound bronchoscope to examine mediastinal lymph nodes. We present a case of sectorial endobronchial ultrasound and the first published case of endoscopic ultrasound elastography using ultrasound bronchoscope in two patients with non-small cell lung carcinoma. Qualitative tissue color pattern was obtained in both cases and correlated with pathological evaluation. The initial feasibility results are promising and suggest that ultrasound bronchoscopy techniques, such as guided nodal staging, merit additional studies. It may be important to categorize the risk of malignancy to facilitate sampling decisions.

Valor de la ecoendoscopia transesofágica en el diagnóstico de localización en el hiperparatiroidismo primario / Oesophageal endoscopic ultrasound in the accurate location of primary hyperparathyroidism (HPT)

Objetivos. Considerar la utilidad de la ecoendoscopia trasesofágica en la localización del hiperparatiroidismo primario recidivado o persistente. Material y método Durante 7 años consecutivos, hemos intervenido a 352 pacientes con hiperparatiroidismo primario (HPP). Sistemáticamente se realiza gammagrafía paratiroidea con 99Tc-sestamibi preoperatorio y determinación intraoperatoria de paratirina. Sólo 5 (1,4%) pacientes han presentado problemas de localización: 3 por persistencia tras cirugía paratiroidea, 1 por recidiva y 1 por HPP con antecedente de hemitiroidectomía derecha. Antes de indicar una cervicotomía exploradora, se decide la realización de una ecoendoscopia trasesofágica para intentar una localización definitiva. Resultados La ecoendoscopia detecta una imagen clara de adenoma con localización precisa en 4 pacientes. Sólo en 1 paciente no se visualiza tumoración. Los 5 pacientes fueron intervenidos. Se confirmó la exactitud del diagnóstico en los 4 pacientes con visualización positiva. La exploración quirúrgica del quinto paciente resultó ser una paratireosis. Los 5 pacientes tuvieron un postoperatorio favorable, sin lesiones recurrenciales ni morbilidad asociada a la ecoendoscopia. Conclusiones La ecoendoscopia trasesofágica resulta muy útil en los hiperparatiroidismo que presenta dificultades para localizar la glándula patológica, especialmente en casos con alteración anatómica por cirugía previa. Así, ayuda a que el cirujano pueda explorar la zona sospechosa de forma más selectiva y más eficiente (AU)

Aim. Our aim was to estimate the usefulness of oesophageal endoscopic ultrasound in the accurate location of recurrent or persistent primary hyperparathyroidism (HPT).Material and methodA total of 352 patients with primary hyperparathyroidism were operated on over the last seven years. A preoperative parathyroid 99Tc- sestamibi gammagraphy and an intraoperative PTH determination were performed routinely. Only 5 patients (1.4%) had localization problems: three with persistent HPT after parathyroid extirpation, one recurrent HPT and one HPT after a right hemithyroidectomy. An oesophageal endoscopic ultrasound was carried out before any new exploratory neck surgery in order to find the definitive location. Results The endoscopic ultrasound showed a clear image of adenoma with an accurate location in four patients. No tumour was present in one patient. All five patients were operated on. The exact location was confirmed in the four patients with positive endoscopic ultrasound images. The fifth surgical exploration revealed a parathyreosis. All five patients had a favourable post-operative period, with no nerve lesions or morbidity associated with the endoscopic ultrasound. Conclusions Oesophageal endoscopic ultrasound is a very useful diagnostic tool in HPT patients with location problems, particularly in cases having anatomical changes due to previous surgery. It is a procedure that helps the surgeon to make a more selective and efficient exploration of parathyroid glands (AU)

[Oesophageal endoscopic ultrasound in the accurate location of primary hyperparathyroidism (HPT)]. / Valor de la ecoendoscopia transesofágica en el diagnóstico de localización en el hiperparatiroidismo primario.

AIM: Our aim was to estimate the usefulness of oesophageal endoscopic ultrasound in the accurate location of recurrent or persistent primary hyperparathyroidism (HPT). MATERIAL AND METHOD: A total of 352 patients with primary hyperparathyroidism were operated on over the last seven years. A preoperative parathyroid 99Tc- sestamibi gammagraphy and an intraoperative PTH determination were performed routinely. Only 5 patients (1.4%) had localization problems: three with persistent HPT after parathyroid extirpation, one recurrent HPT and one HPT after a right hemithyroidectomy. An oesophageal endoscopic ultrasound was carried out before any new exploratory neck surgery in order to find the definitive location. RESULTS: The endoscopic ultrasound showed a clear image of adenoma with an accurate location in four patients. No tumour was present in one patient. All five patients were operated on. The exact location was confirmed in the four patients with positive endoscopic ultrasound images. The fifth surgical exploration revealed a parathyreosis. All five patients had a favourable post-operative period, with no nerve lesions or morbidity associated with the endoscopic ultrasound. CONCLUSIONS: Oesophageal endoscopic ultrasound is a very useful diagnostic tool in HPT patients with location problems, particularly in cases having anatomical changes due to previous surgery. It is a procedure that helps the surgeon to make a more selective and efficient exploration of parathyroid glands.