Emergent endoscopic ultrasound-guided cholecystoduodenostomy does not prevent R0 resection in a pancreaticoduodenectomy for pancreatic cancer.

Endoscopic ultrasound-guided biliary drainage, mainly choledochoduodenostomy, is commonly used as rescue therapy after Endoscopic Retrograde Cholangiopancreatography (ERCP) in malignant distal biliary obstruction due to un-resectable pancreatic cancer. An alternative when the cystic duct is patent and choledochoduodenostomy is not feasible is performing an Endoscopic Ultrasound-gallbladder drainage. The advent of the Lumen Apposing Metal Stents (LAMS) has shortened and simplified this procedure. However, many concerns exist about the performance of these procedures with metal stents preoperatively in resectable tumors. The evidence about Endoscopic Ultrasound-gallbladder drainage before surgery of pancreatic cancer is scarce. An emergent Endoscopic Ultrasound (EUS)-gallbladder drainage (cholecysto-duodenostomy) was performed due to acute cholangitis in the setting of a resectable pancreatic tumor. Surgery after neoadjuvant therapy was done three months later. A complete resection of tumor was feasible. EUS-guided gallbladder drainage using LAMS does not preclude performing a complete resection of a pancreatic head tumor.

Estimulación preoperatoria del asa eferente de la ileostomía con ácidos grasos de cadena corta / Stimulation the efferent limb before loop ileostomy closure with short chain fatty acids

No disponible

Resección de GIST rectal mediante cirugía transanal mínimamente invasiva (TAMIS) tras neoadyuvancia con imatinib / Resection of a rectal gastrointestinal stromal tumour by transanal minimally invasive surgery (TAMIS) after neoadjuvant treatment with Imatinib

Resumen El tratamiento primario de elección para los pacientes con una tumoración GIST localizada es la extirpación quirúrgica completa con márgenes microscópicos negativos. Sin embargo, en un espacio tan reducido como el de la pelvis, la resección completa de una tumo-ración rectal grande es difícil y necesita en ocasiones una amputación abdomino-perienal. En nuestro caso, con la finalidad de reducir el tamaño del tumor y la morbilidad asociada a procedimientos quirúrgicos más agresivos se introdujo el tratamiento con imatinib, con intención neoadyuvante monitorizando la respuesta mediante ecoendoscopia. La respuesta obtenida, rediciendo el volumen tumoral, modificó la estrategia quirúrgica inicial y fue posible conseguir una resección satisfactoria mediante cirugía transanal mínimamente invasiva (TAMIS), preservando los esfínteres anales y soslayando la morbilidad genitourinaria asociada a la excisión mesorectal.

Abstract The primary treatment of choice for patients with a localised gastro-intestinal stromal tumour (GIST) is complete surgical excision with negative microscopic margins. However, in a space as small as that of the pelvis, complete resection of a large rectal tumour is difficult, and sometimes requires an abdominoperineal amputation. In order to reduce the size of the tumour, as well as the morbidity associated with more aggressive surgical procedures, neoadjuvant treatment with Imatinib was introduced in this case, with the response being monitored by of endoscopic ultrasound. The response obtained by reducing the tumour volume modified the strategy, making it possible to obtain a satisfactory resection using transanal minimally invasive surgery (TAMIS), preserving the anal sphincters and avoiding the genitourinary morbidity associated with the mesorectal excision.

Study of the neutron field around ENSA-DPT spent fuel transport and storage casks.

Neutron field measurements around individual DPT type spent fuel transport and storage casks were performed at the storage installation of Trillo Nuclear Power Plant. Neutron spectra were determined at five different positions using a Bonner sphere system. These measurements were used to validate the dosimetry measurements of two neutron monitors. Axial and angular measurements were used to determine the ambient dose equivalent. The results are consistent with the cask design and no field correction is needed when using these monitors.

NEUTRON CHARACTERIZATION OF ENSA-DPT TYPE SPENT FUEL CASK AT TRILLO NUCLEAR POWER PLANT.

The Neutron Standards Laboratory of CIEMAT has conducted the characterization of the independent spent fuel storage installation at the Trillo Nuclear Power Plant. At this facility, the spent fuel assemblies are stored in ENSA-DPT type dual purpose casks. Neutron characterization was performed by dosimetry measurements with a neutron survey meter (LB6411) inside the facility, around an individual cask and between stored casks, and outside the facility. Spectra measurements were also performed with a Bonner sphere system in order to determine the integral quantities and validate the use of the neutron monitor at the different positions. Inside the facility, measured neutron spectra and neutron ambient dose equivalent rate are consistent with the casks spatial distribution and neutron emission rates, and measurements with both instruments are consistent with each other. Outside the facility, measured neutron ambient dose equivalent rates are well below the 0.5 µSv/h limit established by the nuclear regulatory authority.

Neutron field characterization at the independent spent fuel storage installation of the Trillo nuclear power plant.

Neutron fields inside and outside the independent spent fuel storage installation of Trillo Nuclear Power Plant are characterized exhaustively in terms of neutron spectra and ambient dose equivalent, measured by Bonner sphere system and LB6411 monitor. Measurements are consistent with storage casks and building shield characteristics, and also with casks distribution inside the building. Outer values at least five times lower than dose limit for free access area are found. Measurements with LB6411 and spectrometer are consistent with each other.

Boerhaave's syndrome: diagnostic gastroscopy.

A 47-year-old man was attended at the emergency room for severe chest pain after eating sausage with subsequent vomiting and mild upper gastrointestinal bleeding. In the chest radiography we could not see abnormalities. He referred previous episodes of choking without consulting. The urgent gastroscopy detected tertiary contractile activity (nutcracker esophagus) and a foreign body in the lower third of the esophagus. After removing the food bolus, we observed a 4 cm longitudinal tear compatible with esophageal rupture or Boerhaave's syndrome in the right posterior wall of the lower esophagus, proximal to the gastroesophageal junction. Thoracic-abdominal computed tomography (TC) confirmed a perforation of the lower esophagus, with pneumothorax and cervical and chest emphysema. Surgical treatment was indicated: esophageal suture, myotomy and gastric fundoplication. The patient presented good evolution. Boerhaave's syndrome is a rare syndrome, but with high mortality (35%). Mackler triad is very characteristic: vomiting, retrosternal pain and cervical subcutaneous emphysema; but it occurs rarely. Chest radiography is useful, showing abnormalities in up to 90% of patients. The differential diagnosis includes cardiorespiratory disorders: acute myocardial infarction, spontaneous pneumothorax, pericarditis or pneumonia. The role of endoscopy is small, mainly limited to prosthesis placement in high-risk surgical patients. In our case the chest radiograph was initially normal, probably related to bolus impaction and, in presence of upper gastrointestinal bleeding, gastroscopy was performed which allowed us to early diagnosis and treatment.

Lesión de Boerhaave: diagnóstico por gastroscopia / Boerhaave’s syndrome: diagnostic gastroscopy

No disponible