Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum.

BACKGROUND AND STUDY AIMS: Laterally spreading tumors - non granular type (LST-NG) are more often considered candidates for endoscopic submucosal dissection (ESD) than laterally spreading tumors - granular type (LST-G), because of their higher potential for submucosal invasion. However, ESD for LST-NG can be technically difficult. The aim of our study was to compare our ESD results for LST-NG and for LST-G. PATIENTS AND METHODS: Ninety-nine LST-NG and 169 LST-G measuring 20 mm in size or more were removed by ESD. We retrospectively evaluated the clinicopathological features of the tumors and treatment results (en bloc resection rate, procedure time and speed, rate of use of ancillary devices, and complication and recurrence rates). RESULTS: Histopathology revealed that there were more submucosally invasive lesions in the LST-NG than in the LST-G group (28 % vs. 9 %; P < 0.0001). The en bloc resection rate, en bloc R0 resection rate, and en bloc curative resection rate of LST-NG were similar to those of LST-G (LST-NG: 99 %, 98 %, and 88 %; LST-G: 99 %, 98 %, and 91 %). In LST-NG, the median procedure time tended to be longer (LST-NG: 69 min; LST-G: 60 min) and the median procedure speed was slower (LST-NG: 0.15 cm (2)/min; LST-G: 0.25 cm (2)/min; P < 0.0001). Use of ancillary devices was higher for LST-NG (38 % vs. 15 % for LST-G; P < 0.0001), as was the perforation rate (5.1 % vs. 0.6 % for LST-G; P = 0.027). No recurrence was seen in either group. CONCLUSIONS: ESD was an effective treatment method for both LST-NG and LST-G. However, the degree of technical difficulty appears higher for LST-NG than for LST-G lesions, as shown by the lower dissection speed and higher perforation rate. ESD for LST-NG should probably be performed by those with significant experience of colorectal ESD.

Optimization of steroid injection intervals for prevention of stricture after esophageal endoscopic submucosal dissection: A randomized controlled trial.

BACKGROUND: Esophageal endoscopic submucosal dissection enables en bloc resection of large superficial esophageal cancer; however, this procedure may induce severe stricture. Intralesional steroid injection is an effective treatment for prevention of stricture after endoscopic resection; however, there have been no studies assessing the duration of such treatment. The aim of this study was to reduce treatment duration and to evaluate the effectiveness of weekly and biweekly steroid injections in preventing esophageal stricture after endoscopic resection. PATIENTS METHOD: We performed a randomized controlled trial comparing patients receiving weekly or biweekly intralesional triamcinolone injections. Patients with a mucosal defect greater than 75% (3/4) of the luminal circumference after esophageal endoscopic submucosal dissection for superficial esophageal cancers were enrolled. The primary endpoint was the duration of steroid injection treatment. RESULTS: The median duration of treatment was 37.0 days in the weekly group and 34.2 days in the biweekly group (P = 0.059). Among patients with a mucosal defect larger than 50 mm, there was a significant difference in the median duration of treatment between the weekly and biweekly groups (42.5 days vs 29.0 days, P = 0.013). CONCLUSION: Biweekly steroid injection of triamcinolone reduces treatment duration, particularly in those with mucosal defects larger than 50 mm. (Acta gastro-enterol. belg., 2016, 79, 315-320).

A morphologic study of mesotubarium ovarica in the human.

In order to clarify the mechanisms by which the egg is transported from the ruptured follicle into the fimbrial end of the fallopian tube in the human, the mesotubarium ovarica (MTO), the unique anatomic structure which connects the tubal fimbriae and the ovary, was studied in seven human adnexal specimens histochemically and electronmicroscopically. The results demonstrated clearly the presence of smooth muscle cells in the MTO, and failed to demonstrate the presence of cilia in the lining epithelial cells of the MTO. A possible role of the MTO in the mechanisms of ovum pick-up at the time of ovulation is discussed.

A point of discontinuity on the heart rate curve appears in the early stage of exercise.

When measured continuously, the heart rate often appears to hesitate in its elevation momentarily in the early stage of exercise. This phenomenon was called tentatively "a point of discontinuity on a heart rate curve", and was observed in 19 out of 30 healthy subjects. The point appeared when the heart rate reached 87.8 +/- 2.9% (88.3 +/- 2.6% for athletes and 87.4 +/- 3.5% for nonathletes) of the plateau level. The precise cause of the phenomenon was undetermined, however was considered to be normal physiological activities but to be cardiac abnormalities of subjects.

[Correlation between electrical activity in symmetrical regions of the cerebral cortex and unilateral lesions]. / O sootnoshenii elektricheskoi aktivnosti v simmetrichnykh oblastiakh kory mozga pri ego odnostoronnikh proazheniiakh

Functional interrelations between cerebral hemispheres, and particularly, between their symmetrical areas, were studied during compensatory processes in patients with tumours localized in one of the hemispheres. Analysis of spontaneous electrical activity before the operation on the tumour revealed several types of interhemispheric relations. The existence of a sharply pronounced pathological activity in one hemisphere, testifying to inactivation of cortical cells, is, as a rule, accompanied by activation in the intact hemisphere, especially in the areas symmetrical with those injured. In cases of less pronounced pathology, with partial retention of activity of the cortical cells in the injured areas of the affected hemisphere, a lesser degree of activation is observed in the intact hemisphere. The data point to a development of substituting-compensatory processes in the areas of the intact hemisphere symmetrical with the injured ones and to the possibility of testing the processes electrophysiologically.

[Compensatory capabilities of the symmetrical regions of the dominant and subdominant hemispheres of the human brain]. / O kompensatornykh vozmozhnostiakh simmetrichnykh oblastei dominantnogo i subdominantnogo polusharii golovnogo mozga cheloveka

A comparison was made between the EEG characteristics and spectral power of EEG frequencies in symmetrical parts of both cerebral hemispheres in order to elucidate the involvement of these areas in compensatory processes in patients with tumours localized in one of the cerebral hemispheres, before and after the removal of the tumour. Before the operation, the presence of a focus of pathological activity causing inactivation of adjacent cortical cells, is attended with activation of cells in the symmetrical areas of the intact hemisphere. Elimination of the pathological focus results in the fluctuation of interhemispheric asymmetry; for certain time periods inactivation in the sick hemisphere is replaced by activation, while in the intact hemisphere activation changes over to inactivation. The revealed properties are termed by the authors as interhemispheric compensatory conjugation of reactions. They probably reflect the potential possibilities of different areas in the process of compensation.

[Prevention of supraventricular tachysystole with anti-arrhythmia agents]. / Medikamentoznaia profilaktika supraventrikuliarnykh takhisistolii.

The paper substantiates the necessity of using a set of antiarrhythmic drugs for the prevention of supraventricular tachysystoles. In the development of supraventricular tachysystoles an important role is attributed to the disorders in automatic regulation of the sinus node. Cases are described in which the development of paroxysmal cardiac fibrillation with approximately equal intervals of time was caused by an inhibition of the sinus node activity. The set of antiarrhythmic drugs included beta-adrenergic blockers, isocholinic-type drugs, cardiac glycosides, Rauwolfia serpentina preparations, parasympatholitic drugs.

[Differential diagnosis of myocarditis from a number of cardiovascular system diseases]. / Differentsial'naia diagnostika miokarditov s riadom zabolevanii serdechno-sosudistoi sistemy.

The work is based on the analysis of 206 patients with myocarditis of whom 168 had infectious allergic myocarditis and 38 had idiopathic myocarditis. A wide variety of clinical laboratory and instrumental methods of examination was used and intravital puncture biopsy of the myocardium was conducted. The article discusses the criteria of differential diagnosis which make it possible to distinguish the form of myocarditis from a large group of cardiovascular diseases following a similar course, i.e. primary rheumatic carditis, ischemic heart disease, valvular diseases, pericarditis and others.

[Cordarone treatment of parasystole]. / Lechenie parasistolii kordaronom.

Cordarone was used in the treatment of 15 patients with various forms of parasystole. There were 9 cases with ventricular and 5 with atrial parasystole. Cordarone was prescribed according to the following schedule: 200 mg three times daily for the first 10 days and 200 mg twice daily in the next 20 days. A clear positive effect was produced in 14 patients. In 13 cases parasystoles disappeared on the first to tenth day of treatment. The number of parasystoles reduced considerably in one case. The drug had no positive effect on one patient.

The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case-control study.

BACKGROUND: Endoscopic submucosal dissection (ESD) using short needle knives is safe and effective, but bleeding is a problem due to low haemostatic capability. AIM: To assess the performance of a novel ball-tipped needle knife (Flush knife-BT) for ESD with particular emphasis on haemostasis. METHODS: A case-control study to compare the performance for ESD of 30 pairs of consecutive early gastrointestinal lesions (oesophagus: 12, stomach: 32, colorectum: 16) with standard Flush knife (F) vs. Flush knife-BT (BT). Primary outcome was efficacy of intraprocedure haemostasis. Secondary outcomes included procedure time, procedure speed (dividing procedure time into the area of resected specimen), en bloc resection rate and recurrence rate. RESULTS: Median intraoperative bleeding points and bleeding points requiring haemostatic forceps were smaller in the BT group than in the F group (4 vs. 8, P < 0.0001, 0 vs. 3, P < 0.0001). There was no difference between groups for procedure time; however, procedure speed was shorter in the BT group (P = 0.0078). En bloc and en bloc R0 resection rates were 100%, with no perforation or post-operative bleeding. No recurrence was observed in either group at follow-up 1 year postprocedure. CONCLUSIONS: Ball-tipped Flush knife (Flush knife-BT) appears to improve haemostatic efficacy and dissection speed compared with standard Flush knife.

Endoscopic treatment for early stage colorectal tumors: the comparison between EMR with small incision, simplified ESD, and ESD using the standard flush knife and the ball tipped flush knife.

BACKGROUND: Early stage colorectal tumors can be removed by endoscopic mucosal resection but larger such tumors (20 mm) may require piecemeal resection. Endoscopic submucosal dissection (ESD) using newly developed endo-knives has enabled en-block resection of lesions regardless of size and shape. However ESD for colorectal tumor is technically difficult. Therefore, we performed EMR with small incision (EMR with SI) for more reliable EMR, ESD with snaring (simplified ESD) and ESD using the standard Flush knife and the novel ball tipped Flush knife (Flush knife BT) for easier and safer colorectal ESD. AIMS: The aims of our study were (1) to compare the treatment results of the following 3 methods (EMR with SI/si-mplified ESD/ESD) for early stage colorectal tumors, and (2) to assess the performance of Flush knife BT in colorectal ESD. METHODS: We treated 24/44/468 colorectal tumors and examined the clinicopathological features and treatment results such as tumor size, resected specimen size, procedure time, en-bloc resection rate, complication rate. We also treated 58 colorectal tumors (LST-NG:20, LST-G:36, other:2) using standard Flush knife and 80 colorectal tumors (LST-NG:32, LSTG:44, other:2) using Flush knife BT, and examined the clinicopathological features and treatment results mentioned above and also the procedure speed. RESULT: The median tumor size (mm) (EMR with SI/ simplified EMR/ESD) was 20/17/30 (EMR with SI vs. simplified ESD: p = n.s, simplified ESD vs. ESD: p < 0.0001). The median resected specimen size (mm) was 22.5/26/41 (EMR with SI vs. simplified ESD: p = 0.0018, simplified ESD vs. ESD: p < 0.0001). The procedure time (min.) was 19/27/60 (EMR with SI vs. simplified ESD: p = n.s, simplified ESD vs. ESD: p < 0.0001) The en-block resection rate (%) was 83.3/90.9 /98.9. The complication rate (post-operative bleeding rate/perforation p=n.s). In the treatment results of ESD for LSTs by knives, there was no difference between standard Flush knife and Flush knife BT for clinicopathological features and treatment results (procedure time, complication rate and en bloc R0 resection rate). However, procedure speed (cm2/min.) of LST-G was significantly faster in the Flush knife BT than in standard Flush knife. (standard Flush knife: 0.21 vs. Flush knife BT: 0.27, p = 0.034). CONCLUSION: EMR with small incision (EMR with SI) and ESD with snaring (simplified ESD) are good option to fill the gap between EMR and ESD in the colorectum, and also considered to become the nice training for the introduction of ESD. Flush knife BT appears to improve procedure speed compared with standard Flush knife, especially for LST-G in colo-rectal ESD.