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3.
Endoscopy ; 42(5): 419-22, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20340070

RESUMO

To reduce the risk of complications related to endoscopic submucosal dissection (ESD), we developed a new grasping-type scissors forceps (GSF), which can grasp and incise the targeted tissue using an electrosurgical current. We prospectively evaluated the efficacy and safety of ESD using GSF for the removal of colorectal tumors in 10 consecutive patients. After the submucosa had been injected with a solution, the lesion was separated from the surrounding normal mucosa by complete incision around the lesion using the GSF. A piece of submucosal tissue was grasped and cut with the GSF using an electrosurgical current to achieve submucosal excision. All lesions were treated easily and safely with no unexpected incisions. No delayed hemorrhage or perforation occurred. En bloc resection was obtained in all cases. The tumor-free lateral/basal margins were obtained in eight out of 10 patients. ESD using GSF appears to be an easy, safe, and technically efficient method for resecting early colorectal tumors.


Assuntos
Colonoscópios , Colonoscopia/métodos , Neoplasias Colorretais/cirurgia , Dissecação/instrumentação , Mucosa Intestinal/cirurgia , Idoso , Neoplasias Colorretais/diagnóstico , Intervalo Livre de Doença , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Colorectal Dis ; 12(10 Online): e320-5, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19863598

RESUMO

AIM: Acute haemorrhagic rectal ulcer (AHRU) is characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients who have serious illness. Endoscopic diagnosis and management of AHRU is, however, still controversial. We retrospectively investigated 95 AHRU patients to elucidate the clinical characteristics, endoscopic findings and haemostatic strategies. METHOD: Between January 1999 and March 2007, 95 patients were diagnosed with AHRU in our hospital. Medical records and colonoscopy files were reviewed. Clinical features, colonoscopic findings, haemostatic treatment and outcome of the patients were evaluated. RESULTS: Eighty per cent of the patients were bedridden at the onset. The most frequent underlying disorder was cerebrovascular disease (36.8%). Hypoalbuminaemia (< 3.5 g/dl) was seen in 92.6% of the patients. Endoscopic findings of AHRU were classified as circumferential ulcer (41.1%), linear or nearly round small ulcer(s) (44.2%), circumferential and small ulcer(s) (7.4%) and Dieulafoy-like ulcer (7.4%). Primary endoscopic haemostatic treatment was performed in 45.3% of cases. Recurrent bleeding occurred in 24.2% of patients. Permanent haemostasis was achieved by secondary endoscopic treatment in 82.6% of re-bleeding patients. CONCLUSION: Understanding the typical clinical and endoscopic findings and careful endoscopic examination are important for the accurate diagnosis of AHRU, and endoscopic haemostatic therapy may be effective for bleeding patients.


Assuntos
Hemorragia Gastrointestinal/patologia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Doenças Retais/patologia , Doenças Retais/terapia , Úlcera/patologia , Úlcera/terapia , Idoso , Colonoscopia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipoalbuminemia/complicações , Masculino , Doenças Retais/complicações , Recidiva , Estudos Retrospectivos , Úlcera/complicações
8.
Endoscopy ; 39(12): 1103-5, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18072064

RESUMO

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure that is associated with a high complication rate. The shortcoming of this method is the difficulty in fixing the knife to the target lesion. This difficulty can lead to unexpected incision, resulting in major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using an electrosurgical current. The ESD procedure using the GSF was carried out in an animal model (resected porcine stomachs in vitro). After marking the lesion and injecting a solution into the submucosa, the lesion was separated from the surrounding normal mucosa following complete incision around the lesion using the GSF. A piece of submucosal tissue was grasped and cut with the GSF using an electrosurgical current to achieve submucosal exfoliation. ESD using the GSF was carried out safely and easily without unintentional incision. ESD using GSF appears to be an easy, safe, and technically efficient method for resecting gastrointestinal neoplasms.


Assuntos
Mucosa Gástrica/cirurgia , Gastroscopia/métodos , Estômago/cirurgia , Instrumentos Cirúrgicos , Animais , Endoscopia/métodos , Desenho de Equipamento , Segurança de Equipamentos , Modelos Animais , Sensibilidade e Especificidade , Suínos
9.
Surg Endosc ; 20(9): 1431-4, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16703428

RESUMO

BACKGROUND: No consensus exists as to the best endoscopic treatment for Mallory-Weiss syndrome. Endoscopic band ligation is a readily available and easily learned technique. This prospective study evaluated the efficacy and safety of endoscopic band ligation therapy for Mallory-Weiss syndrome. METHODS: From August 1998 to June 2005, a clinical trial assessed 37 patients with a diagnosis of Mallory-Weiss syndrome who had active bleeding, exposed vessels, or both. Their lesions were treated using endoscopic band ligation. RESULTS: Endoscopic band ligation was successful in 36 of 37 cases, with a follow-up period ranging from 1 to 24 months. The remaining patient had severe liver failure and disseminated intravascular coagulation. The patient bled again at 12 h and subsequently died. Except for this case, no recurrent bleeding, perforation, or other complications occurred. CONCLUSIONS: The study results suggest that endoscopic band ligation is an effective, safe, and easily learned procedure for treating upper gastrointestinal bleeding related to Mallory-Weiss syndrome.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Síndrome de Mallory-Weiss/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Coagulação Intravascular Disseminada/complicações , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Seguimentos , Hemorragia Gastrointestinal/mortalidade , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Falência Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Resultado do Tratamento
10.
Acta Gastroenterol Belg ; 68(2): 272-5, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16013651

RESUMO

A 60-year-old Japanese man was referred for treatment of a polypoid oesophageal tumour. Radiographic examination of the upper gastrointestinal tract disclosed a nodule with central depression in the lower esophagus. By endoscopy the nodule was yellowish and appeared submucosal. Endoscopic ultrasonography demonstrated a hypoechoic solid tumour limited in submucosa without lymph node involvement. Endoscopic resection using band ligation was performed under guidance by endoscopic ultrasonography. By histologic examination the tumour consisted of large cells arranged in nests. These cells had abundant granular cytoplasm and small round nuclei. They expressed S-100 protein and were CD68, and periodic acid-Schiff positive. No expression of alpha-smooth muscle actin was noted. The tumour was limited in submucosa. Findings were consistent with complete endoscopic resection. This report may be the first concerning an oesophageal granular cell tumour successfully treated with EUS-guided endoscopic resection using band ligation.


Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/cirurgia , Esofagoscopia/métodos , Tumor de Células Granulares/diagnóstico por imagem , Tumor de Células Granulares/cirurgia , Biópsia por Agulha , Endossonografia/métodos , Neoplasias Esofágicas/patologia , Seguimentos , Tumor de Células Granulares/patologia , Humanos , Imuno-Histoquímica , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estadiamento de Neoplasias , Medição de Risco , Resultado do Tratamento
11.
Br J Radiol ; 78(929): 419-21, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15845935

RESUMO

Colonic muco-submucosal elongated polyp is a new clinical entity first reported in 1998. The purpose of this report is to determine the value of endoscopic ultrasound in the diagnosis of this condition. We reviewed the endosonographic and histological findings of seven colonic muco-submucosal elongated polyps that were removed completely by endoscopic resection or surgery. The lesions appeared as pedunculated submucosal tumours, measuring 1-4 cm in maximal diameter. Endosonographically, all lesions consisted of mucosal and submucosal layers, and microcystic components were found in the submucosal layer. There were no echogenic masses or muscularis propria within the polyps. These endosonographic features corresponded to histological findings of this type of polyp which was covered with normal mucosa and composed of submucosal layer alone. The submucosal layer consisted of oedematous, loose, connective tissue and/or fibrous tissue, accompanied by dilated blood vessels and lymphatics. Endoscopic ultrasound enabled differentiation of colonic muco-submucosal elongated polyp from other submucosal lesions.


Assuntos
Pólipos do Colo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia , Diagnóstico Diferencial , Endossonografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
Am J Med Genet ; 104(4): 299-302, 2001 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-11754064

RESUMO

We describe a woman with 15q11.2-q14 duplication who had clinical manifestations of proximal 15q trisomy and hyperpigmentation. Within this region, the P gene, located at chromosome segment 15q11.2-q12, is associated with oculocutaneous albinism type II (OCA2) and with hypopigmentation in the Prader-Willi and Angelman chromosome 15q deletion syndromes. We therefore hypothesized that in this woman skin hyperpigmentation might result from a duplication of the P gene. We carried out chromosomal and interphase fluorescence in situ hybridization (I-FISH) analyses, and determined that the P gene is duplicated in this woman. Our findings demonstrate that trisomy of the P gene can be associated with skin hyperpigmentation.


Assuntos
Proteínas de Transporte/genética , Aberrações Cromossômicas , Cromossomos Humanos Par 15/genética , Hiperpigmentação/patologia , Proteínas de Membrana/genética , Proteínas de Membrana Transportadoras , Bandeamento Cromossômico , Feminino , Duplicação Gênica , Humanos , Hiperpigmentação/genética , Hibridização in Situ Fluorescente , Pessoa de Meia-Idade , Trissomia
16.
Br J Radiol ; 74(887): 1017-22, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11709467

RESUMO

The objective of this study was to examine the accuracy of a 12 MHz ultrasound catheter probe in the pre-operative staging of colorectal cancer by assessing the depth of tumour infiltration and involvement of pericolonic lymph nodes. 159 patients with colorectal cancer who underwent ultrasound examination with a 12 MHz catheter probe were studied prospectively. The results of this imaging procedure were compared with the histological findings of the resected specimens. The accuracy of the 12 MHz ultrasound catheter probe for depth of invasion (T category) was 85% (131/154) for all tumours, 87% (46/53) for pT1 tumours, 60% (9/15) for pT2 tumours, 89% (74/83) for pT3 tumours and 67% (2/3) for pT4 tumours. The accuracy for tumours of the rectum and colon was 81% and 89%, respectively. The accuracy of the probe for nodal staging (N category) was 67% (76/114) overall. The sensitivity was 70% (33/47), the specificity 64% (43/67), the positive predictive value 58% (33/57) and the negative predictive value 75% (43/57). Endoscopic ultrasound using a 12 MHz catheter probe accurately assessed tumour stage, although nodal staging remained suboptimal. This method may aid in the selection of treatment for patients with colorectal cancer.


Assuntos
Colo , Neoplasias Colorretais/diagnóstico por imagem , Endossonografia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/patologia , Endossonografia/métodos , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Prospectivos
17.
Surg Laparosc Endosc Percutan Tech ; 11(3): 189-94, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11444750

RESUMO

Liver cirrhosis is a critical factor contributing to morbidity and mortality in abdominal surgery, because patients with cirrhosis have a particularly high risk of developing bleeding, infection, and ascites. Laparoscopic appendectomy (LA) recently has gained a lot of attention around the world; however, comparisons between the benefits of LA and those of conventional open appendectomy (OA) for patients with liver cirrhosis have yet to be sufficiently compiled. In the present retrospective study, 40 patients with liver cirrhosis who were diagnosed with acute appendicitis before surgery underwent an appendectomy (OA in 25 patients and LA in 15 patients). This study focused on the operative time, amount of postoperative pain, use of analgesics, the restart of a normal diet, number of complications, length of hospital stay, and cost-effectiveness of the procedure in such patients. The amount of postoperative pain and the length of hospital stay were significantly smaller in the LA group. The mean values of the serum C-reactive protein on postoperative days 1, 3, and 7 were significantly less in the LA group. The number of wound infections and wound bleeding was also less in the LA group. The difference in the total cost of hospitalization was not significant. The cost of the operation was greater in the LA group than in the OA group, whereas the hospitalization cost in the LA group was less than that in the OA group. The results of this study suggest that LA may be superior to OA for the treatment of postoperative pain and postoperative complications for patients with liver cirrhosis. Long-term follow-up studies are still necessary, however, to determine any possible decrease in the number of late complications.


Assuntos
Apendicectomia/métodos , Apendicite/complicações , Apendicite/cirurgia , Laparoscopia , Cirrose Hepática/complicações , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória , Período Pós-Operatório , Estudos Retrospectivos
18.
Am J Med Genet ; 101(2): 153-7, 2001 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-11391659

RESUMO

We report a Japanese woman with de novo 6p monosomy and 10q trisomy [46,XX,der(6)t(6;10)(p25.1;q25.2)] whose clinical manifestations resemble those of xeroderma pigmentosum (XP) and Cockayne syndrome (CS), known as premature aging syndromes. She had a history of easy sunburning and presented a number of freckles and hypopigmented spots on her face as those of XP. Magnetic resonance imaging and computed tomography scanning demonstrated intracranial abnormalities like those seen in CS. DNA repair studies using the patient's fibroblasts demonstrated hypersensitive responses to ultraviolet (UV). XP, CS, and UV-sensitive syndromes with photosensitivity disturbances have been known as DNA repair abnormalities. However, an association of 6p monosomy with these diseases has not been reported so far. Molecular analysis of the patient we described may contribute to the identification of novel DNA-repair-related gene(s) and/or to the senile mechanism.


Assuntos
Transtornos de Fotossensibilidade/patologia , Translocação Genética , Adulto , Sobrevivência Celular/efeitos da radiação , Bandeamento Cromossômico , Cromossomos Humanos Par 10/genética , Cromossomos Humanos Par 6/genética , Reparo do DNA , Relação Dose-Resposta à Radiação , Feminino , Fibroblastos/citologia , Fibroblastos/efeitos da radiação , Humanos , Cariotipagem , Transtornos de Fotossensibilidade/etiologia , Pele/citologia , Pele/efeitos da radiação , Raios Ultravioleta/efeitos adversos
20.
Am J Gastroenterol ; 96(5): 1429-34, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11374678

RESUMO

OBJECTIVES: Recently, intraductal papillary-mucinous tumor (IPMT) of the pancreas has increasingly been recognized. However, differential diagnosis between benign and malignant IPMT is often difficult using conventional imaging modalities. The purpose of this study was to retrospectively investigate the value of endoscopic ultrasonography (EUS) for differentiating malignant from benign IPMT. METHODS: A total of 51 patients with IPMT were preoperatively examined by EUS. The endosonograhic findings were compared with histopathological findings of the resected specimens. RESULTS: In main duct type IPMT, the diameter of the main pancreatic duct (MPD) was > or =10 mm in seven of the eight malignant tumors, compared with two of the seven benign tumors (p < 0.05). In branch duct type IPMT, three of the four large tumors (>40 mm) with irregular thick septa were malignant lesions. In both main duct type IPMT and branch duct IPMT, eight patients had large mural nodules (>10 mm); seven of the eight tumors were malignant and one of the eight tumors was benign. When the tumor was diagnosed as malignant according to above three findings, EUS was able to differentiate between malignant and benign IPMT with an accuracy of 86%. CONCLUSIONS: Main duct type tumors with > or =10 mm dilated MPD, branch duct type tumors (>40 mm) with irregular septa, and large mural nodules (>10 mm) strongly suggest malignancy on EUS. EUS would be a useful modality for differentiating between benign and malignant IPMT.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Papilar/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Papilar/patologia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia , Ultrassonografia
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