ABSTRACT
SUMMARY Our case report shows the complexity of dealing with tracheal tumors, highlighting the importance of the method used for staging. In this report, endoscopic ultrasound (EUS) was crucial to identify the involvement of the esophageal muscular propria in a tracheal tumor and change the surgical planning of the case. Staging this kind of tumor represents a challenge for physicians. There is no evidence in the literature on which methods represent the gold standard for T staging.
RESUMO Neste relato de caso mostramos a complexidade em lidar com tumores traqueais, destacando a importância do método usado para estadiamento. Neste relato, a ecoendoscopia (EUS) foi fundamental para identificar o envolvimento da camada muscular própria esofágica por um tumor traqueal e alterar o planejamento cirúrgico do caso. O estadiamento desse tipo de tumor representa um desafio para os médicos. Não há evidências na literatura sobre quais métodos representam o padrão ouro para o estadiamento T.
Subject(s)
Humans , Male , Aged , Tracheal Neoplasms , Carcinoma, Squamous Cell/diagnostic imaging , Endosonography/methods , Bronchoscopy/methods , Esophageal Neoplasms/pathology , Esophageal Neoplasms/diagnostic imaging , Tracheal Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Positron Emission Tomography Computed Tomography , Neoplasm StagingABSTRACT
Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.
Resumo Pancreatite necrosante com coleções pode ocorrer como complicação da pancreatite aguda. O manejo desses pacientes depende da gravidade e envolve múltiplas modalidades médicas de tratamento, como terapia clínica intensiva e intervenção cirúrgica. Neste artigo, mostramos um caso grave de necrose pancreática com ótima resolução clínica após drenagem endoscópica.
Subject(s)
Humans , Female , Adult , Drainage/methods , Endoscopy, Digestive System/methods , Pancreatitis, Acute Necrotizing/surgery , Pancreatitis, Acute Necrotizing/diagnostic imaging , Plastics , Prosthesis Design , Severity of Illness Index , Tomography, X-Ray Computed , Drainage/instrumentation , Reproducibility of Results , Treatment Outcome , EndosonographyABSTRACT
PURPOSE: To evaluate the diagnosis improvement of EUS-FNA when using ROSE performed by the endosonographer. METHODS: A retrospective study was conducted. A total of 48 pancreatic solid masses EUS-FNA were divided into two groups according to the availability of on-site cytology (ROSE) - the first 24 patients (group A-without ROSE) and the latter 24 cases (group B-with ROSE). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, complications and inadequacy rate of EUS-FNA were determined and compared. RESULTS: Among the 48 EUS-FNA, the overall performance was: sensitivity 82%; specificity 100%; positive predictive value (PPV) 100%; negative predictive value (NPV) 70% and accuracy 87%. The sensitivity of the Group A was 71%, versus 94% in-group B (p=0.61). Moreover, the negative predictive value was 58% versus 87% (p=0.72). The accuracy rate increased from 79% to 96% (p=0.67) in the ROSE group. The number of punctures was similar between the groups. No major complications were reported. CONCLUSION: Rapid on-site cytopathological examination, even when performed by the endosonographer, may improve the diagnostic performance in the diagnosis of solid pancreatic lesions, regardless of the slight increase in the number of punctures. .
Subject(s)
Humans , Endoscopic Ultrasound-Guided Fine Needle Aspiration/standards , Endosonography/standards , Pancreas/pathology , Pancreatic Diseases/pathology , Adenocarcinoma/pathology , Adenocarcinoma , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Endosonography/methods , Prospective Studies , Pancreas , Pancreatic Diseases , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms , Quality Improvement , Reproducibility of Results , Retrospective Studies , Sensitivity and SpecificityABSTRACT
PURPOSE: To present an option technique during the accomplishment of a "Roux-en-Y" hepaticojejunostomy that, allows future transgastric endoscopic access to the biloenteric anastomosis. METHODS: The side-to-side "Roux-en-Y" hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel. A distal jejunal loop of approximately 10,0 to 15,0 cm must be kept far from the anastomosis that allows its setting, without tension, in the anterior gastric wall bellow the small bending, between body and of the stomach antrum. Once the jejunal segment is fixed on the anterior gastric wall, this will allow future endoscopic access to the bilioenteric anastomosis, carried through transgastric punction guided by endoscopic-ultrasound (EUS). CONCLUSION: The modified "Roux en Y" hepaticojejunostomy is a simple and new technique to permit an alternative transgastric endoscopic access to bilioenteric anastomosis. .