Assuntos
Antituberculosos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Idoso , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Progressão da Doença , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Prednisolona/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. OBJECTIVE: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD. MATERIAL AND METHODS: We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard). RESULTS: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm(2)/min vs. 14.3 +/- 9.3 mm(2)/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm(2)/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm(2)/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). CONCLUSION: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.
Assuntos
Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Neoplasias Gástricas/cirurgia , Instrumentos Cirúrgicos , Animais , Endoscopia Gastrointestinal/efeitos adversos , Curva de Aprendizado , Masculino , SuínosRESUMO
Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the "digestive tract", gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the "Sociedad Española de Endoscopia Digestiva" (SEED), "Sociedad Española de Patología Digestiva" (SEPD) and the "AsociaciónEspañola de Gastroenterología", have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Humanos , Neoplasias Pulmonares , Estadiamento de NeoplasiasRESUMO
Epidermoid cysts represent roughly 1% of all intracranial tumors. They are frequently located in the cerebellopontine angle but rarely extend to the supratentorial brain. Epilepsy is an extremely uncommon manifestation of this neoplasm. We suggest the surgical management of a 35-year-old male who presented with a six-month history of intractable temporal lobe epilepsy. His seizures were characterized by a focal onset in the form of déjà vu experiences, followed by a secondarily generalized tonic-clonic seizure. Imaging revealed a heterogeneous cystic mass in the right cerebellopontine angle, extending supratentorially causing a mass effect on the mesial temporal region. Gross total resection was achieved through a combined subtemporal-retrosigmoid approach. Histopathology revealed an epidermoid cyst. The patient was entirely seizure-free at the three-month follow-up. Epidermoid cysts may present with epileptic seizures. Seizure freedom can be achieved with surgical management in most cases. The patient's symptoms, imaging findings, and epileptogenic focus must be considered to select the appropriate surgical strategy.
Assuntos
Actinomicose/etiologia , Esofagite Eosinofílica/complicações , Actinomicose/tratamento farmacológico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Asma/complicações , Asma/tratamento farmacológico , Transtornos de Deglutição/etiologia , Quimioterapia Combinada , Esofagite Eosinofílica/dietoterapia , Esofagite Eosinofílica/tratamento farmacológico , Hérnia Hiatal/complicações , Humanos , Imunocompetência , Masculino , Fumar/efeitos adversosAssuntos
Endoscopia Gastrointestinal/normas , Mucosa Gástrica/cirurgia , Neoplasias Gastrointestinais/cirurgia , Mucosa Intestinal/cirurgia , Guias de Prática Clínica como Assunto , Neoplasias Colorretais/cirurgia , Dissecação/normas , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Medição de Risco , Espanha , Neoplasias Gástricas/cirurgia , Resultado do TratamentoAssuntos
Anticoagulantes/uso terapêutico , Cirrose Hepática Alcoólica/complicações , Veia Porta , Trombose Venosa/tratamento farmacológico , Antitrombina III/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Proteína C/metabolismo , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagemRESUMO
OBJECTIVES: To investigate the diagnostic efficacy of magnetic resonance cholangiopancreatography (MRCP) in choledocholithiasis and to determine whether use of MRCP may eliminate the need for purely diagnostic endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: A total of 116 patients with suspected biliopancreatic pathology were studied prospectively between November 1996 and February 1998. Choledocholithiasis was initially suspected in 61 patients and rated before ERCP and MRCP as being of low, intermediate, or high probability based on clinical, laboratory, and/or imaging findings (Cotton criteria). RESULTS: The sensitivity of choledocholithiasis diagnosis was 91%, with a global efficacy of 90%. The level of duct stone obstruction was visualized in all patients. Suprastenotic dilatation also showed a good correlation to ERCP. Choledocholithiasis was found in 32 patients (65%) and 3 patients (33%) in the high- and intermediate-probability groups, respectively. None of the low-probability patients had choledocholithiasis. Endoscopic retrograde cholangiopancreatography was performed for only a diagnostic (not therapeutic) purpose in 3 patients (6%) and 2 patients (22%) of the high- and intermediate-probability cases, respectively. CONCLUSIONS: Magnetic resonance cholangiopancreatography seems to be effective in diagnosing choledocholithiasis. It plays a fundamental role in patients with a low or intermediate risk of choledocholithiasis, contributing to the avoidance of purely diagnostic ERCP.
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares/diagnóstico , Imageamento por Ressonância Magnética/métodos , Idoso , Ampola Hepatopancreática/patologia , Neoplasias dos Ductos Biliares/patologia , Colestase/diagnóstico , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Actinomicose/complicações , Esofagite Eosinofílica/complicações , Transtornos de Deglutição/etiologia , Doxiciclina/uso terapêutico , BiópsiaRESUMO
Background: Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. Objective: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with highpressure water jet and to compare with standard ESD. Material and methods: We performed a prospective nonsurvival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed atotal of 50 gastric ESD (30 hybrid-knife and 20 standard). Results: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04).Hybrid-knife ESD was faster than standard (time: 44.6 ± 21.4 minutes vs. 68.7 ± 33.5 minutes; p = 0.009 and velocity: 20.8 ± 9.2 mm2/ min vs. 14.3 ± 9.3 mm2/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 ± 15.68 to 28.18 ± 20.07 mm2/min; p= 0.615 and standard: From 6.4 ± 0.3 to 19.48 ± 19.21 mm2/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). Conclusion: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybridknife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results (AU)
No disponible
Assuntos
Animais , Endoscopia Gastrointestinal/métodos , Dissecação/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Gástricas/cirurgia , Modelos Animais de DoençasRESUMO
No disponible
Assuntos
Humanos , Endoscopia Gastrointestinal/métodos , Dissecação/instrumentação , Neoplasias Gástricas/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Plexo Submucoso/cirurgiaRESUMO
El cáncer de pulmón es una de las neoplasias más frecuentes en nuestro medio y la principal causa de muerte por cáncer en países occidentales. El manejo diagnóstico y terapéutico de estos pacientes es complejo, desempeñando en el mismo un papel muy relevante la punción guiada por ultrasonografía endoscópica (USE-PAAF), que clásicamente realizan los gastroenterólogos. Al tratarse de una enfermedad no relacionada con el aparato digestivo, los gastroenterólogos han tenido que actualizar sus conocimientos en este campo, para diagnosticar de forma adecuada a este nutrido grupo de pacientes. La incorporación en estos últimos años de nuevas y prometedoras técnicas, como la punción aspirativa transbronquial guiada por ecobroncoscopia (USEB-PAAF), han modificado el acercamiento al diagnóstico y estadificación de estos pacientes. En la presente guía clínica, la Sociedad Española de Endoscopia Digestiva (SEED), la Sociedad Española de Patología Digestiva (SEPD) y la Asociación Española de Gastroenterología (AEG), han aunado esfuerzos para actualizar el grado de conocimiento existente sobre este tema y dar recomendaciones basadas en la evidencia a sus miembros (AU)
Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the digestive tract, gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the Sociedad Española de Endoscopia Digestiva (SEED), Sociedad Española de Patología Digestiva (SEPD) and the Asociación Española de Gastroenterología, have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Biópsia por Agulha/instrumentação , Biópsia por Agulha/métodos , Carcinoma/complicações , Carcinoma/diagnóstico , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/tendências , Endoscopia do Sistema Digestório , Sociedades Médicas/ética , Sociedades Médicas/legislação & jurisprudência , Sociedades Médicas/normas , Biópsia por Agulha , Endoscopia do Sistema Digestório/instrumentação , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Sociedades MédicasRESUMO
Ultrasonography (US) is currently the reference technique for evaluating gallbladder pathology. The aim of this study was to prospectively determine the diagnostic efficacy of magnetic resonance cholangiography (MRCP) in evaluating the gallbladder, as compared with US. The study included 80 patients (mean age, 69.3 years; male-to-female ration, 1.3:1) who underwent prospective US and MRCP; 5 patients in whom MRCP was contraindicated were excluded. In all cases, US was performed before MRCP. Ultrasound was the reference technique for evaluating MRCP sensitivity and specificity. Magnetic resonance cholangiopancreatography provided good image quality in 65 patients (81.2%) and poor image quality in 15 (mostly because of poor patient cooperation). Artefacts did not influence visualization of the gallbladder or evaluation of the background pathology. The sensitivity of MRCP in diagnosing gallbladder stones (43 patients; 97.7%) was comparable to US (44 patients). In contrast, MRCP diagnosed biliary sludge or microlithiasis in 13 patients, versus 5 in the case of US. Magnetic resonance cholangiopancreatography is a good technique for diagnosing cholelithiasis and biliary sludge. However, its high cost, contraindications, and the need for patient cooperation limit the use of the technique in routine clinical gallbladder studies. Magnetic resonance cholangiopancreatography could contribute to the diagnosis of microlithiasis, provided that future studies confirm its greater sensitivity versus US.
Assuntos
Bile/diagnóstico por imagem , Colangiografia , Colelitíase/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Imageamento por Ressonância Magnética , Idoso , Feminino , Vesícula Biliar/diagnóstico por imagem , Humanos , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , UltrassonografiaRESUMO
OBJECTIVE: To date, ERCP has been the reference technique in the diagnosis of pancreatic duct pathology. The aim of the present study was to evaluate the accuracy of magnetic resonance cholangiopancreatography (MRCP), a relatively new, noninvasive diagnostic method, in studying the pancreatic duct. METHODS: A prospective 15-month study was done of 78 patients with suspected biliopancreatic pathology and indications for ERCP. In all cases, MRCP was performed <72 h before ERCP. Both techniques were used to assess the size of the pancreatic tract (normal or dilated), the presence or absence of obstruction, the level of obstruction where present, and its etiology. RESULTS: Both techniques found the pancreatic tract to be normal and nondilated in 60 patients. The specificity and sensitivity of MRCP in evaluating the normal pancreatic duct were 98% and 94%, respectively. In nine cases, a stenotic duct of Wirsung was detected (seven at the head of the pancreas and two in the body), with the same correlation being shown by ERCP (sensitivity 100%). The sensitivity and specificity of MRCP relating to diffuse irregular and dilated morphologies of the entire pancreatic duct was 86% and 100%, respectively. Nine patients were diagnosed with pancreatic neoplasms by both techniques, with an accuracy of 100%. Four patients presented chronic pancreatitis, which was correctly diagnosed by MRCP in each case. CONCLUSIONS: MRCP is an effective technique for evaluating both the normal and diseased duct of Wirsung, and for establishing the underlying pathology.