Place of plasma argon coagulation in the treatment of vascular abnormalities of the digestive tract in adults

The aim of our study is to evaluate the value of Argon Plasma Coagulation in the treatment of gastrointestinal vascular abnormalities. Patients and methods: This is a descriptive and analytical retrospective study, from January 2009 to September 2020. 198 patients who have benefited from treatment with Argon Plasma Coagulation for vascular anomalies of the digestive tract divided into 2 groups: -Group A: Patients with radial rectitis lesions (n = 107). -Group B: Patients with lesions of digestive angiodysplasia (n = 91). Results: The mean age of our patients was 64.95 ± 9.88 years [43 - 83] in group A, while in group B the mean age was 65.19 ± 14.29 years [40 - 91] with a clear male predominance in 72.5%. The majority of patients in group A were followed for prostate cancer in 33,8%, and 26.3% of patients in group B had chronic renal failure, followed by stomach cancer in 15.8%, and esophageal cancer in 10.5%. Clinical symptomatology was dominated by rectories in 40.2% in group A versus 46.8% in group B. Rectal involvement was dominated in group A in 98.1%, whereas in group B the lesions were mainly located in the stomach in 60.5%. The endoscopic evolution was favorable in all our patients with a clear improvement of rectal lesions and digestive angiodysplasia lesions. The total complication rate in our series was nil. Conclusion: Plasma Argon coagulation is a very effective method in the endoscopic treatment of digestive haemorrhages with good tolerability and a low complication rate. (AU)

Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases / Coagulação por plasma de argônio como adjuvante à curetagem estendida em tumores de células gigantes do osso: Um estudo de 50 casos

Abstract Objective Extended curettage with adjuvants of giant cell tumors of bone is associated with a lower rate of recurrence of the tumor while preserving the adjacent joint. The present study was conducted to estimate the recurrence rate and functional outcome after using argon beam as an adjuvant for extended curettage. Methods We selected 50 patients with giant cell tumors, meeting all the inclusion criteria, who underwent extended curettage using high speed burr and argon beam photocoagulation between July 2016 to January 2019. On their follow-up visit, they were assessed for any complaints of pain and signs like tenderness, locally raised temperature, and decreased range of motion of the adjacent joint. Radiologically, the patients were assessed for any increased lucency around the cement mantle and uptake of the subarticular graft. Musculoskeletal Tumor Society Score (MSTS) was administered to the patients, and range of motion of the adjacent joint was compared with the contralateral joint. Results Recurrence was found in 4 patients, that is, an 8% recurrence rate. Twenty-six out of 28 patients with a tumor in the lower limb had a grade-5 weight bearing status 6 months from the surgery, and their range of motion was comparable to contralateral healthy joint with an average MSTS score of 27 (18-30). Conclusion Extended curettage of giant cell tumors using argon beam coagulation is associated with low recurrence rates of the tumor and is an effective modality in the treatment of these tumors besides having a functional outcome comparable to the healthy limb.

Resumo Objetivo A curetagem estendida com adjuvantes de tumores de células gigantes do osso está associada a uma menor taxa de recidiva da neoplasia e à preservação da articulação adjacente. Este estudo foi feito para estimar a taxa de recidiva e o resultado funcional após o uso de plasma de argônio como adjuvante à curetagem estendida. Métodos Cinquenta pacientes com tumores de células gigantes que atendiam a todos os critérios de inclusão foram selecionados para o estudo e submetidos à curetagem estendida com broca de alta velocidade e fotocoagulação com plasma de argônio entre julho de 2016 e janeiro de 2019. À consulta de acompanhamento, os pacientes foram avaliados quanto a quaisquer queixas de dor e sinais como sensibilidade, aumento local da temperatura e diminuição da amplitude de movimento da articulação adjacente. Radiologicamente, os pacientes foram avaliados quanto à presença de qualquer aumento de radiotransparência ao redor do manto de cimento e incorporação do enxerto subarticular. O questionário Musculoskeletal Tumor Society Score (MSTS) foi administrado aos pacientes e a amplitude de movimentação da articulação adjacente foi comparada à articulação contralateral. Resultados Quatro pacientes apresentaram recidiva, o que corresponde a uma taxa de 8%. Seis meses após a cirurgia, 26 de 28 pacientes com tumor no membro inferior tinham capacidade de sustentação de peso de grau 5 e amplitude de movimento comparável à articulação saudável contralateral, com pontuação MSTS média de 27 (intervalo de 18 a 30). Conclusão A curetagem estendida de tumores de células gigantes com coagulação por plasma de argônio está associada a baixas taxas de recidiva da neoplasia; é uma modalidade eficaz no tratamento desses tumores e o resultado funcional é comparável ao do membro saudável.

Efficacy of argon plasma coagulation for hemorrhagic chronic radiation proctitis / 肿瘤研究与临床

Objective:To investigate the efficacy and safety of argon plasma coagulation (APC) in the treatment of patients with hemorrhagic chronic radiation proctitis (HCRP).Methods:The clinical data of 36 HCRP patients who received APC treatment in Shanxi Province Cancer Hospital between January 2017 and June 2021 were retrospectively analyzed. The severity of HCRP was assessed by using the Zinicola endoscopic score and the Vienna proctoscopy score. The elimination of rectal bleeding or occasional bloody stools that did not require further treatment within 6 months of the last APC treatment was considered to be the therapy success.Results:The median follow-up time was 1.63 years (0.85-2.68 years). There were 20 (55.6%) patients with severe HCRP according to the Zinicola endoscopic score. After APC treatment, 32 patients with HCRP obtained adequate rectal hemostasis, whereas 4 patients with severe HCRP still experienced rectal bleeding symptoms after APC treatment for several times. All patients received APC treatment for (2.7±1.0) times in total. The endoscopic scores of HCRP patients before and after APC treatment were (3.6±0.8) scores, (1.4± 1.1) scores, respectively; Vienna proctoscopy scores were (3.8±0.8) scores, (1.2±1.1) scores, respectively; and the differences were statistically significant ( t values were 22.37, 18.96; all P < 0.001). The hemoglobin levels of HCRP patients before and after APC treatment were (85±15) g/L, (100±17) g/L, respectively, and the difference was statistically significant ( t = 17.86, P < 0.001). Serious side effects including strictures, perforations, or fistulas and other severe complications related to APC therapy were not found. Conclusions:APC may be an effective and safe treatment option for patients with HCRP.

Study on the damage of primary branches of the Glisson system in the hepatic portal by argon plasma coagulation with different spraying time / 中华肝胆外科杂志

Objective:To investigate the effect of different spray-coagulation time of argon plasma coagulation (APC) injury on the Glisson system primary branche(G1) in the hepatic portal of pigs.Methods:Fifty clean healthy domestic pigs (27 females and 23 males, aged 7 to 14 months) were selected, with the body weighted (100.0±9.5) kg. They were randomly divided into five groups (A, B, C, D, and E), with 10 pigs in each group. G1 models were made and sprayed by APC for 1, 2, 3, 4, and 5 seconds. The damage, maximum damage area, maximum damage depth, and damage of the three branches of the Glisson system (the first branches of the portal vein, intrahepatic bile duct, and hepatic artery) were compared among the groups. The pigs were divided into two groups based on whether the three branches were damaged or not: the three-branch damage group ( n=23) and the control group ( n=27). The maximum damage area and maximum damage depth were compared between the two groups. Results:After the APC spraying, circular or elliptical damage appeared on the surface of the G1, with changes such as yellow-brown color, brown color, charred appearance, and defects. Under the microscope, G1 capsule was found to be deficient, the fibrous tissue beneath the capsule was ruptured, and the structures of small blood vessels and small bile ducts were incomplete. " Burn marks" and damage to the three branches of the Glisson system in G1 were also observed, and the damage was more severe at the center of the spray-coagulation. As the spray-coagulation time increased, the maximum damage area of the G1 model also increased, and the two were positively correlated ( r=0.90, P<0.001). The maximum damage depth was also positively correlated with spray-coagulation time ( r=0.97, P<0.001). The numbers of pigs with damage to the three branches of the Glisson system in Groups A-E were 0, 2, 5, 6, and 10, respectively, and the number of pigs with damage increased with the spray-coagulation time. In the three-branch damage group, the spray-coagulation time, maximum damage area, and maximum damage depth were all higher than those in the control group (without three-branch damage), and the differences were statistically significant (all P<0.05). Conclusion:The degree of damage to G1 caused by APC is positively correlated with the spray-coagulation time, and damage to the three branches of the Glisson system in G1 is related to the maximum damage area, maximum damage depth, and APC spray-coagulation time.

Endoscopic ablation combined with fundoplication plus acid suppression-duodenal diversion procedure for long segment barrett´s esophagus: early and long-term outcome / Ablação endoscópica combinada com fundoplicatura associada a diversão duodenal no esôfago de barrett longo: resultados precoce e de longo prazo

ABSTRACT BACKGROUND: The addition of endoscopic ablative therapy plus proton pump inhibitors or fundoplication is postulated for the treatment of patients with long-segment Barrett´s esophagus (LSBE); however, it does not avoid acid and bile reflux in these patients. Fundoplication with distal gastrectomy and Roux-en-Y gastrojejunostomy is proposed as an acid suppression-duodenal diversion procedure demonstrating excellent results at long-term follow-up. There are no reports on therapeutic strategy with this combination. AIMS: To determine the early and long-term results observed in LSBE patients with or without low-grade dysplasia who underwent the acid suppression-duodenal diversion procedure combined with endoscopic therapy. METHODS: Prospective study including patients with endoscopic LSBE using the Prague classification for circumferential and maximal lengths and confirmed by histological study. Patients were submitted to argon plasma coagulation (21) or radiofrequency ablation (31). After receiving treatment, they were monitored at early and late follow-up (5-12 years) with endoscopic and histologic evaluation. RESULTS: Few complications (ulcers or strictures) were observed after the procedure. Re-treatment was required in both groups of patients. The reduction in length of metaplastic epithelium was significantly better after radiofrequency ablation compared to argon plasma coagulation (10.95 vs 21.15 mms for circumferential length; and 30.96 vs 44.41 mms for maximal length). Intestinal metaplasia disappeared in a high percentage of patients, and histological long-term results were quite similar in both groups. CONCLUSIONS: Endoscopic procedures combined with fundoplication plus acid suppression with duodenal diversion technique to eliminate metaplastic epithelium of distal esophagus could be considered a good alternative option for LSBE treatment.

RESUMO RACIONAL: A adição de terapia ablativa endoscópica associado a inibidores da bomba de prótons ou fundoplicatura tem sido postulada para o tratamento de pacientes com esôfago de Barrett de segmento longo (EBSL), no entanto, essa conduta não evita o refluxo ácido/biliar nesses pacientes. A fundoplicatura com gastrectomia distal e gastrojejunostomia em Y de Roux (FGD-Y) foi proposta como procedimento de supressão de ácido, demonstrando excelentes resultados no seguimento a longo prazo. Não há relatos na literature com a combinação dessa estratégia terapêutica. OBJETIVOS: Determinar os resultados precoces e a longo prazo observados em pacientes com EBSL com ou sem dysplasia de baixo grau, submetidos a FGD-Y, combinado com terapia endoscópica. MÉTODOS: Estudo prospectivo incluindo pacientes com EBSL, empregando a classificação de Praga, sendo o comprimento circunferencial (C) e máximo (M) e confirmado por estudo histológico. Os pacientes foram submetidos à coagulação com plasma de argônio (CPA, 21 pacientes) ou ablação por radiofrequência (ARF, 31 pacientes). Após o tratamento, eles foram seguidos precoce e tardiamente (5-12 anos), mediante avaliação endoscópica e histológica. RESULTADOS: Foram observadas poucas complicações após o procedimento (úlcera ou estenose). Re-tratamento foi necessário em ambos os grupos de pacientes. A redução do comprimento do epitélio metaplásico foi significativamente melhor após ARF em comparação com CPA (10,95 versus 21,15 mm para C e 30,96 versus 44,41 mm para M). A metaplasia intestinal desapareceu em elevada porcentagem de pacientes, e os resultados histológicos a longo prazo foram bastante semelhantes em ambos os grupos. CONCLUSÕES: Procedimentos endoscópicos combinados com fundoplicatura e gastrectomia distal e gastrojejunostomia em Y de Roux, para eliminar o epitélio metaplásico do esôfago distal podem ser considerados uma boa opção alternativa para o tratamento da EBSL.

Development of adenocarcinoma after radiofrequency ablation of barrett's esophagus associated to fundoplication and suppression-duodenal diversion procedure: a lesson to be learned / Adenocarcinoma em esôfago de barrett após ablação por radiofrequência associada a fundoplicatura e diversão duodenal

ABSTRACT Despite endoscopic eradication therapy being an effective and durable treatment for Barrett's esophagus-related neoplasia, even after achieving initial successful eradication, these patients remain at risk of recurrence and require ongoing routine examinations. Failure of radiofrequency ablation and argon plasma coagulation is reported in 10-20% of cases.

RESUMO Apesar de a terapia de erradicação endoscópica ser um tratamento eficaz e durável para a neoplasia relacionada ao esôfago de Barrett (BE), mesmo após a erradicação inicial bem-sucedida, esses pacientes permanecem em risco de recorrência e requerem exames de rotina contínuos. A falha na ablação por radiofrequência e na coagulação com plasma de argônio é relatada em 10-20% dos casos.

Tratamiento endoscópico del esófago de Barrett con displasia de bajo y alto grado / Endoscopic treatment of Barrett's esophagus with low- and high-grade dysplasia

RESUMEN Introducción: El esófago de Barrett es una condición esofágica adquirida, que puede evolucionar a un adenocarcinoma. Con el paso de los años, la terapia endoscópica ha remplazado la cirugía en el tratamiento de esta afección. Objetivos: Mostrar los resultados de la aplicación de la técnica de resección endoscópica de la mucosa y la ablación con Hibrid-APC en pacientes portadores de esófago de Barrett con displasia de bajo o alto grado. Métodos: Se realizó un estudio descriptivo y retrospectivo en 29 pacientes entre los años 2014-2019, en el Servicio de endoscopias del Centro Nacional de Cirugía de Mínimo Acceso. Se estudiaron variables sociodemográficas, se estableció la clasificación endoscópica del esófago de Barrett, se describieron las características de la lesión, el diagnóstico histológico, la terapéutica endoscópica, la presencia de complicaciones, la resección incompleta y recidiva. Se aplicaron técnicas de estadística descriptiva y métodos no paramétricos. Resultados: Predominó el sexo masculino (58,62 %) y el grupo de 41-60 años (58,62 %). El segmento corto con lesiones planas y el largo con lesiones elevadas fueron más frecuentes (37,93 %). Se realizaron 15 resecciones y 14 ablaciones con Hibrid-APC; se observó una estenosis como complicación de la resección endoscópica de la mucosa y recidivas con ambas técnicas (5 pacientes, 17 %), tres relacionadas con la resección y dos con el Hibrid-APC. El Hibrid-APC alcanzó una efectividad terapéutica del 85,71 % y la resección del 80 %. Conclusiones: El tratamiento endoscópico con displasia de bajo y alto grado, mostró ser un procedimiento efectivo y seguro, con bajo porciento de complicaciones y recidivas.

ABSTRACT Introduction: Barrett's esophagus is an acquired esophageal condition that can evolve into an adenocarcinoma. Over the years, endoscopic therapy has replaced surgery in the treatment of this condition. Objectives: to show the results of the application of the endoscopic mucosal resection and Hybrid-APC ablation technique in patients with Barrett's esophagus with low-grade or high-grade dysplasia. Methods: a descriptive and retrospective study was carried out in 29 patients between 2014 and 2019, in the Endoscopy service of the National Center for Minimal Access Surgery. Social and demographic variables were studied; endoscopic classification of Barrett's esophagus was established, as well as the characteristics of the lesion, histological diagnosis, endoscopic therapy, the presence of complications, incomplete resection and recurrence were described. Descriptive statistics techniques and non-parametric methods were applied. Results: male gender (58.62%) and the group aged 41-60 years (58.62%) predominated. The short segment with flat lesions and the long segment with raised lesions were more frequent (37.93%). A number of 15 resections and 14 ablations were performed with Hybrid-APC; one stricture was observed as a complication of endoscopic mucosal resection and recurrences with both techniques (5 patients, 17%), three related to resection and two to Hybrid-APC. The Hybrid-APC achieved a therapeutic effectiveness of 85.71% and the resection one of 80%. Conclusions: endoscopic treatment with low- and high-grade dysplasia proved to be an effective and safe procedure, with a low percentage of complications and recurrences.

Argon plasma coagulation in radiation-induced proctitis

Abstract Background Argon plasma coagulation (APC) is a non-tactile ablative therapy that helps to stop rectal bleeding in patients who have developed actinic proctitis after exposure to radiotherapy. This approach seems to be more effective than medications or surgical procedures. Objective To review the literature to verify the effectiveness of APC in the treatment of patients with actinic proctitis induced by radiation therapies. Methods A systematic search was conducted on the following databases: MEDLINE/PubMed, LILACS, SCIELO, and the Cochrane Central Register of Controlled Trials. We identified 81 studies, and 5 of them fulfilled the inclusion criteria. Results In the articles included, a total of 236 patients were evaluated. Most of them were men (67.7%) with a mean age of 66.6 years. Prostate cancer was the main cause of actinic proctitis (67.3%), and control of the bleeding was achieved in 83.3% of the cases, after a mean of 1.67 session of APC. Moreover, 66 patients had complications with the treatment, and rectal pain was the most referred. Conclusions Argon plasma coagulation is a well-tolerated and effective treatment to control rectal bleeding in patients who underwent radiotherapy, and the number of sessions varies from 1 to 2, according to the case. (AU)

Argón plasma: respuesta terapéutica y calidad de vida en pacientes con proctitis actínica crónica hemorrágica / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: La proctitis actínica crónica hemorrágica (PACH) se presenta secundaria a la radioterapia pélvica. La coagulación con argón plasma (APC) es una terapéutica eficaz, segura, de fácil uso y relativo bajo costo. Objetivo: Describir la respuesta terapéutica a corto y largo plazo del APC en pacientes con PACH, así como evaluar la calidad de vida antes y después de la intervención. Material y Métodos: Estudio observacional, prospectivo de serie de casos en 46 pacientes con PACH, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso entre 2017 y 2020. Se emplearon medidas de resumen y comparación de medias (t de Student pareada) para la hemoglobina inicial y final, así como para los puntajes de calidad de vida aplicados antes y después de la intervención. Para determinar el tiempo libre de resangrado se utilizó l Método de Kaplan-Meier. Se estimó una significación menor a 0.05 para un intervalo de confianza de 95 por . Resultados: Se necesitó una media de 3,6 ± 2,394 sesiones de APC. La media de hemoglobina se incrementó 1,9 g/L. La respuesta terapéutica a corto plazo se observó en 100 por ciento de los pacientes y a largo plazo en 91,3 . La media de puntaje para la calidad de vida descendió en 12,065 puntos (p˂ 0,00), La percepción global percibida se incrementó en una media de 7.326 puntos (p˂ 0,00). Conclusiones: El APC tiene buena respuesta terapéutica a corto y largo plazo con pocas sesiones y bajo número de complicaciones, con mejoría de la calidad de vida de los pacientes(AU)

Introduction: Chronic hemorrhagic radiation proctitis (CHRP) appears secondary to pelvic radiotherapy. Argon plasma coagulation (APC) is an effective, safe, easy-to-use, and relatively inexpensive therapy. Objective: To describe the short- and long-term therapeutic response of APC in patients with CHRP, as well as to evaluate the quality of life before and after the intervention. Material and Methods: Observational, prospective case series study of 46 patients with CHRP, treated at the National Center for Minimally Access Surgery between 2017 and 2020. Summary measures and comparison of means (paired Student's t-test) were used for baseline and final hemoglobin, as well as for the quality of life scores applied before and after the intervention. The Kaplan-Meier method was used to determine the recurrence free time. A level of significance less than 0.05 was estimated for a 95 por ciento confidence interval. Results: A mean of 3,6 ± 2,394 APC sessions was required. The mean hemoglobin increased 1,9 g / L. Short-term therapeutic response was observed in 100 % of patients, and long-term in 91,3 por ciento. The mean score for quality of life decreased by 12,065 points (p˂ 0,00). The perceived global perception increased by a mean of 7,326 points (p˂ 0,00). Conclusions: APC has a good therapeutic response in the short and long term with few sessions and a low number of complications, with an improvement in the quality of life of the patients(AU)

Study on the efficacy and safety of combination of sufficient argon plasma coagulation cauterization and clipping in the treatment of colonic diverticular bleeding / 中华消化杂志

Objective:To evaluate the efficacy and safety of combination of sufficient argon plasma coagulation(APC) cauterization and clipping in the treatment of colonic diverticular bleeding.Methods:From June 2018 to April 2022, the clinical data of patients were retrospectively analyzed, who visited Department of Gastroenterology of Air Force Medical Center due to overt gastrointestinal bleeding, and were confirmed or suspected to have colonic diverticular bleeding and received combination of sufficient APC cauterization and clipping treatment. The deadline for follow-up was September 30, 2022. During the follow-up after endoscopic treatment, the re-bleeding rate, hemoglobin level difference between the last follow-up and before treatment, wound healing under colonoscopy as well as the intraoperative and postoperative complications of patients were statistically analyzed. Descriptive analysis was used for statistical analysis.Results:A total of 15 patients were enrolled, including 13 males and 2 females, aged (60.8±14.8) years old. The course of the disease was 1 day to 13 years. A total of 145 colonic diverticula of 15 patients were treated under endoscopy. The median follow-up time was 14.5 months (5.3 to 49.5 months) months. Among the 15 patients, 12 patients received endoscopic therapy once and no bleeding occurred till the end of follow-up. Three patients suspected with diverticular bleeding received a second endoscopic treatment because of bleeding at the 12 days, 3 months and 8 months after the first treatment, respectively.No rebleeding occurred after the second endoscopic therapy till the end of follow-up. The re-bleeding rate of the first treatment was 3/15 and the re-bleeding rate of re-treatment was 0. At the end of follow-up, the hemoglobin concentration increased (35.9±26.3) g/L compared with that before the treatment. Two patients had perforation during operation and were closed with multiple titanium clips. There was no abdominal pain or other symptoms after operation. And the patients were discharged 3 and 4 days after treatment, respectively. Two patients suffered short-term postoperative wound bleeding and successful hemostasis was achieved after endoscopic treatment. One patient developed postoperative infection and the symptoms disappeared after anti-infection treatment.Conclusions:Combination of sufficient APC cauterization and titanium clipping is safe and effective in the treatment of colonic diverticular bleeding. For patients with dominant diverticular hemorrhage, or patients with recurrent gastrointestinal bleeding, if other etiology are excluded and colonic diverticular bleeding is highly suspected, the combination of sufficient APC cauterization and titanium clipping under endoscopy is feasible.

Obesity and social representations among patients subjected to argon plasma coagulation (APC) / Obesidade e representações sociais entre pacientes submetidos à coagulação de plasma de argônio (APC) / Obesidad y representaciones sociales entre pacientes sujetos a coagulación de plasma de argón (APC)

This study sought to identify the Social Representations of Obesity among 15 individuals who underwent bariatric surgery through the Roux-en-Y Gastric Bypass (RYGB) method and were subjected to Argon Plasma Coagulation (APC) due to weight relapse. Data were collected through interviews and analyzed via Descending Hierarchical Classification. Obesity was associated with physical limitations and difficulties in social relationships. Prejudice and difficulty in changing habits are associated with the choice to undergo surgical treatment and to weight relapse. The suffering that goes along with obesity and the difficulty in changing habits seem to be associated with the search for surgical help.

Este estudo procurou identificar as representações sociais da obesidade entre 15 indivíduos submetidos à cirurgia bariátrica pelo método Bypass Gástrico em Y de Roux (RYGB) e submetidos à Coagulação por Plasma de Argônio (APC) devido à recidiva de peso. Os dados foram coletados através de entrevistas e analisados por meio da Classificação Hierárquica Descendente. A obesidade foi associada a limitações físicas e dificuldades nas relações sociais. Preconceito e dificuldades na mudança de hábitos estão associados à escolha de se submeter a tratamento cirúrgico e à recidiva de peso. O sofrimento que acompanha a obesidade e a dificuldade de mudar hábitos parecem estar associados à busca de ajuda cirúrgica.

Este estudio buscó identificar las representaciones sociales de la obesidad entre 15 individuos que se sometieron a cirugía bariátrica utilizando el método de bypass gástrico Roux-en-Y (RYGB) y que se sometieron a coagulación con plasma de argón (APC) debido a una recaída en el peso. Los datos fueron recolectados a través de entrevistas y analizados utilizando la Clasificación Jerárquica Descendente. La obesidad se asoció con limitaciones físicas y dificultades en las relaciones sociales. Los prejuicios y las dificultades para cambiar los hábitos están asociados con la opción de someterse a un tratamiento quirúrgico y una recaída del peso. El sufrimiento que acompaña a la obesidad y la dificultad para cambiar los hábitos parecen estar asociados con la búsqueda de ayuda quirúrgica.

El Hybrid-APC en el tratamiento endoscópico del esófago de Barrett / The Hybrid-APC in the endoscopic treatment of Barrett'sesophagus

RESUMEN Fundamento: debido al riesgo de evolución insatisfactoria de los pacientes con esófago de Barrett hacia el adenocarcinoma esofágico, es necesaria la aplicación de técnicas seguras y efectivas que logren prevenir el desenlace hacia lesiones malignas esofágicas. El Hybrid-APC (Argón plasma coagulación) es una de estas técnicas que permiten detener la historia natural del esófago de Barrett en su etapa inicial. Objetivo: realizar una revisión y reflexión acerca del tratamiento endoscópico del esófago de Barrett con el Hybrid-APC. Métodos: se realizó una búsqueda en los motores Google, PudMed, SciELO regional, SciELO Public Health, National Library of Medicine PudMed. En la estrategia de la búsqueda se utilizaron los términos: esófago de Barrett, tratamiento endoscópico, Hybrid-APC. Se evaluaron los documentos en extensos y se desarrolló un documento resumen de la información recolectada. En la búsqueda bibliográfica realizada se encontraron 20 trabajos relacionados con esófago de Barrett, tratamiento endoscópico 10 y específico del uso del Hybrid-APC cinco. Resultados: los estudios reportaron la efectividad y seguridad de la ablación con el Hybrid-APC en el tratamiento endoscópico del esófago de Barrett con displasia de bajo grado; y en la displasia de alto grado y carcinoma in situ remanente, luego de una resección mucosa endoscópica. Conclusiones: el tratamiento endoscópico del esófago de Barrett con Hybrid-APC, se considera una técnica alternativa para detener la evolución de esta enfermedad hacia el adenocarcinoma. Esto generará motivación para entrenamientos y su puesta en práctica de forma generalizada.

ABSTRACT Background: due to the risk of unsatisfactory evolution of patients with Barrett's esophagus (EB) towards esophageal adenocarcinoma, it is necessary to apply safe and effective techniques that prevent the outcome towards esophageal malignant lesions. The Hybrid-APC (argon plasma coagulation) is one of these techniques that allow stopping the natural history of EB in its initial stage. Objective: to conduct a review and reflection on the endoscopic treatment of Barrett's esophagus with the Hybrid-APC. Methods: a search was conducted on Google, PudMed, SciELo regional, SciELo Public Health, National Library of Medicine PudMed engines. The search strategy used the terms: Barrett's esophagus, endoscopic treatment, Hybrid-APC. Extensive documents were evaluated and a summary document of the information collected was developed. The literature search found 20 works related to Barrett's esophagus, ten on endoscopic treatment, and five on specific to the use of Hybrid-APC. Results: studies reported the effectiveness and security of the ablation with the Hybrid-APC in the endoscopic treatment of Barrett's esophagus with low degree dysplasia, and in the high degree dysplasia and remnant carcinoma in situ, after the endoscopic mucous resection. Conclusions: the endoscopic treatment of Barrett's esophagus with Hybrid-APC is considered an alternative technique to stop the evolution of this pathology towards adenocarcinoma. This will generate motivation for training and its implementation in a generalized way.

Aplicação de plasma de argônio endoscópico para tratamento do reganho de peso após cirurgia bariátrica em uma clínica privada de Florianópolis / Using of endoscopic argon plasma for treatment of weight regain after bariatric surgery in a private clinic in Florianópolis

Introdução: Atualmente o bypass gástrico em Y de Roux (BGYR) é o método cirúrgico de escolha no tratamento da obesidade. Todavia, pode ocorrer reganho de peso após a cirurgia. A aplicação do plasma de argônio por via endoscópica constitui uma opção terapêutica que visa redução do calibre da anastomose gastrojejunal, com consequente perda de peso. Objetivo: Avaliar a relação da redução do calibre da anastomose gastrojejunal com a perda de peso e sensação de saciedade nos pacientes que readquiriram peso após BGYR. Métodos: Estudo observacional transversal, que incluiu 34 pacientes submetidos à aplicação do plasma de argônio entre 2014 e 2018, na Usuy Clínica Médica em Florianopólis. As diferenças entre as médias de peso, IMC e diâmetro da anastomose gastrojejunal frente a aplicação do plasma de argônio e saciedade referida foram estabelecidas pelo teste de Wilcoxon (p≤0,05). Resultados: Observou-se redução de 6,26% do peso, 6,21% do IMC e 43,04% do diâmetro anastomótico comparando as médias pré e pós seis meses do procedimento. 53,3% dos pacientes sentiram-se mais saciados. Conclusão: A aplicação do plasma de argônio mostrou-se eficaz na redução do diâmetro da anastomose gastrojejunal, perda de peso corporal e diminuição do IMC.

Introduction: Nowadays the Roux-en-Y Gastric Bypass (RYGB) is the surgical choice method in obesity treatment. However, weight regain may occur after the surgery. The endoscopy applied argon plasma constitutes one therapeutic option in order to reduce the gastrojejunal anastomosis caliber and consequently weight loss. Objective: To evaluate the relation between the gastrojejunal anastomosis caliber reduction, weight loss and sensation of satiety in patients who regained weight after RYGB. Methods: Observational cross-sectional study that includes 34 patients submitted to argon plasma application between 2014 and 2018 at the Usuy Medical Center in Florianopolis. Weight averages, Body Mass Index (BMI) and gastrojejunal anastomosis diameter differences regarding argon plasma application and referred satiety were established by the Wilcoxon Test (p ≤ 0,05). Results: A reduction of 6.26 % of the weight, 6.21 % of the BMI and 43.04 % of the anastomotic diameter was observed upon comparing the average rate six months before and after the procedure. 53.3 % of the patients felt more satiated. Conclusion: The argon plasma application was effective in reducing gastrojejunal anastomosis diameter, body weight and BMI.

Preliminary clinical analysis of radiation proctitis treated with argon plasma coagulation combined with submucosal injection / 中华放射肿瘤学杂志

Objective To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP),especially for refractory RP.Methods Clinical data of 22 RP patients were retrospectively analyzed.The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman's classification (B).The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment).Results All 22 patients were successfully treated.Among them,18 patients (82％) had no bleeding.According to the classification of A,15 patients (68％) had mild proctitis and 7(32％) experienced severe proctitis.Based on B classification,9 patients (41％) were categorized as mild proctitis and 13(59％) as severe proctitis.Using the classification of A,the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score) (Spearman's r=0.86,P＜0.001).Conclusions Preliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP,but also maintains long-term efficacy for refractory RP.Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.

Preliminary clinical analysis of radiation proctitis treated with argon plasma coagulation combined with submucosal injection / 中华放射肿瘤学杂志

Objective@#To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP), especially for refractory RP.@*Methods@#Clinical data of 22 RP patients were retrospectively analyzed. The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman′s classification (B). The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment).@*Results@#All 22 patients were successfully treated. Among them, 18 patients (82%) had no bleeding. According to the classification of A, 15 patients (68%) had mild proctitis and 7(32%) experienced severe proctitis. Based on B classification, 9 patients (41%) were categorized as mild proctitis and 13(59%) as severe proctitis. Using the classification of A, the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score)(Spearman’s r=0.86, P<0.001).@*Conclusions@#Preliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP, but also maintains long-term efficacy for refractory RP. Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.

Bronchoscopic ablative therapy in modern pediatric interventional respiratory diseases / 中国实用儿科杂志

Bronchoscopic ablative therapy, which is mainly used in airway obstructive diseases, includes laser,thermo-coagulation(electrocautery,and argon plasma coagulation)and cryotherapy. The thermal ablation and frozen cut can quickly destroy the obstructions in the airway,such as the granulation tissue,scar tissue and tumors. In the meanwhile,the freezing and thawing technique can effectively inhibit the granulation tissue and scar tissue regeneration. Timely,standardized and integrated application of bronchoscopic ablation is the key to gaining the safe and effective treatment in children with severe airway obstructive diseases.

Study on the killing effect of cold atmospheric pressure plasma on MRSA Staphylococcus aureus in vitro and in vivo infection model

Aims@#Non-thermal atmospheric-pressure plasma (cold plasma), is described as a partly ionized gas. Cold plasma is a new method of medicine for killing the bacteria, treatment of cancer diseases, accelerates the healing of infectious ulcers, especially in infection caused by Meticillin-resistant Staphylococcus aureus (MRSA). This study aimed to investigate the impact of Non-thermal atmospheric-pressure plasma on MRSA S. aureus organism isolated from burn wound infection in vitro and in vivo. @*Methodology and results@#Five MRSA S. aureus strains were recovered in burn patients from Shahid Motahari Burns Hospital, Tehran, Iran. They confirmed by microbiology and biochemical tests. Antibiotic susceptibility testing was performed using Kirby Bauer Disk Diffusion Method with selected antibiotics. Then, the antibacterial impact of atmospheric non-thermal plasma on MRSA in vitro and in vivo at different times was assessed. After that, the tissue was randomly separated from control and treated mice with plasma and transferred to the Histopathology Laboratory for further evaluation. Results of the inactivation of MRSA by non-thermal atmospheric plasma showed no bacterial growth. Also, results of the impact of non-thermal helium plasma in vivo environment revealed that, in addition to healing in the animal wound, the burn wounds infection was healed and treated according to the histological results. @*Conclusion, significance and impact of study@#Our results confirmed the inactivation of MRSA S. aureus, healing of animal burn wound and complete treatment by non-thermal atmospheric plasma. It recommended that cold plasma can be used for the treatment of burn wounds infection due to the gentle on the human skin.

Ectasia vascular antral gástrica. Presentación clínica y manejo terapéutico / Gastric antral vascular ectasia. Clinical presentation and therapeutic management

La ectasia vascular gástrica antral es una causa infrecuente de hemorragia gastrointestinal alta, responsable de aproximadamente el 4% de las hemorragias gastrointestinales altas no varicosas. El diagnóstico se basa en los hallazgos endoscópicos y su tratamiento más aceptado es la coagulación con argón plasma. Se presenta un caso de una mujer con hemorragias digestivas altas recurrentes en forma de melenas y anemia, a la cual se le realizó endoscopía digestiva alta diagnosticándole ectasias vasculares de antro gástrico. Posteriormente, se le indica tratamiento de coagulación con argón plasma de forma satisfactoria y sin complicaciones. El presente trabajo tiene como objetivo la revisión de una causa inusual de sangrado digestivo y su tratamiento.

Gastric antral vascular ectasia is an infrequent cause of high gastric hemorrhage, responsible of the 4% of high gastric non-variceal hemorrhages. The diagnosis is based on endoscopic findings and its most accepted treatment is argon plasma coagulation. It is presented a case of a woman with recurrent digestive hemorrhages in the form of melena and anemia, who was performed a high digestive endoscopy with resulting a diagnosis of vascular ectasia of the gastric antro. Later she was treated satisfactorily with argon plasma coagulation without complications. The resent work is aimed at reviewing an unusual cause of digestive bleeding and its treatment.

Influence of nonthermal argon plasma on the shear bond strength between zirconia and different adhesives and luting composites after artificial aging

PURPOSE: Plasma activation of hydrophobic zirconia surfaces might be suitable to improve the bond strength of luting materials. The aim of this study was to analyze the influence of nonthermal argon-plasma on the shear bond strength (SBS) between zirconia and different combinations of 10-MDP adhesive systems and luting composites after artificial aging. MATERIALS AND METHODS: Two hundred forty Y-TZP specimens were ground automatically with 165 µm grit and water cooling. Half of the specimens received surface activation with nonthermal argon-plasma. The specimens were evenly distributed into three groups according to the adhesive systems ([Futurabond U, Futurabond M, Futurabond M + DCA], VOCO GmbH, Germany, Cuxhaven) and into further two subgroups according to the luting materials ([Bifix SE, Bifix QM], VOCO GmbH). Each specimen underwent artificial aging by thermocycling and water storage. SBS was measured in a universal testing machine. Statistical analysis was performed using ANOVA and Scheffè procedure with the level of significance set to 0.05. RESULTS: Surface activation with nonthermal plasma did not improve the bond strength between zirconia and the tested combinations of adhesive systems and luting materials. The plasma-activation trended to reveal higher bond strength if the self-etch luting material (Bifix SE) was used, irrespective of the adhesive system. CONCLUSION: Plasma-activation seems to be suitable to improve bond strength between zirconia and self-etch resin materials. However, further research is necessary to identify the influence of varying plasma-parameters.