Electromagnetic assisted endoscopic submucosal dissection is more efficient than water-jet assisted and conventional ESD in experimental model.

BACKGROUND AND STUDY AIMS: The adequate visualization of the dissection line, inside the submucosal layer, supposes the main challenging issue in ESD. For this reason, several counter traction methods have been developed focused on overcoming this handicap. One of which, Magnetic anchor guided - ESD (MG-ESD) is an attractive alternative. However, the usefulness of this approach has been scarcely assessed and compared with other ESD strategies. Therefore, the aim of this study is to compare three different ESD alternatives in experimental faction. METHODS: This was a prospective non-randomized study, in which three different ESD techniques were performed in an ex-vivo gastric porcine model by an endoscopist slight expertise in ESD: conventional ESD, waterjet assisted ESD and MG-ESD. MG-ESD was performed using two different magnets: inner Neodymiun ringed shape magnet attached to the simulated lesions by an endoclip and external electromagnet connected to a Single Output Adjustable 24V/0.3A Power Supply Unit. RESULTS: Forty-six ESD procedures were performed: 24 conventional ESD, 12 waterjet-assisted ESD and 10 MG-ESD. Average size of the simulated lesions was 33.86 mm. No differences in terms of safety and efficacy were registered between the three approaches. Nevertheless, MG-ESD proved to be faster and more efficient than conventional ESD and water-jet assisted ESD (min per cm 2 10.85 vs. 7.43 vs. 3,41; P  = 0.001). CONCLUSIONS: MG-ESD could be a feasible alternative to conventional ESD even at the beginning of the learning curve. Therefore, researches focused on developing appropriate ESD magnetic devices and further comparative studies must be promoted, in order to assess the reliable usefulness of the magnet-assistance in ESD.

Síndrome de Horner tras analgesia epidural para el parto. Informe de 3 casos / Horner syndrome after epidural analgesia for labor. Report on three cases

Epidural analgesia is assumed to be the technique of choice for the relief of pain in labor. Multiple adverse neurological effects have been reported, one of which is the so-called Horner syndrome (ptosis, myosis, anhidrosis). Its evolution is usually benign and does not require specific management, except clinical monitoring for the more than probable cephalic spread of local anesthetic. Most of the cases that exist in the literature are isolated; in our work we present a series of 3 clinical cases and review the pathogenesis and management in the obstetric patient.

La analgesia epidural supone la técnica de elección para el alivio del dolor del parto. Se han descrito múltiples efectos adversos a nivel neurológico, uno de ellos es el llamado Síndrome de Horner (ptosis,miosis, anhidrosis), suele presentar evolución benigna y no requiere manejo especifico, salvo vigilancia clínica por la más que probable difusión cefálica del anestésico local. La mayor parte de los casos existentes en la literatura son aislados, en nuestro trabajo presentamos una serie de 3 casos clínico y repasamos su etiopatogenía y manejo en la paciente obstétrica.

Cavitating mesenteric lymph node syndrome: a rare complication of celiac disease.

Among the many complications of celiac disease, mesenteric lymph node syndrome cavitated is considered one of the rarest, there is few case series published in the literature. The etiology and pathophysiology are unknown but because of its high mortality rate, estimated to be around 50%, it should recognize at an early stage in order to institute appropriate therapy as soon as possible.

¿Son útiles los antisecretores en el manejo de la hemorragia digestiva alta no varicosa? / Are anti-secretory drugs useful for the management of non-variceal upper gastrointestinal haemorrhage?

La hemorragia digestiva alta no varicosa supone la causa más importante de sangrado digestivo, siendo una consulta frecuente en los servicios de urgencias hospitalarios. El tratamiento médico basado en el uso de inhibidores de la bomba de protones (IBP), junto con el tratamiento endoscópico, ha demostrado disminuir de manera significativa las tasas de resangrado, mejorando la supervivencia de estos pacientes. Después de dos décadas desde la comercialización de los (IBP), a día de hoy sigue existiendo controversia en cuanto a su dosificación y forma de administración en los pacientes con hemorragia digestiva de origen péptico (AU)

Non-variceal upper gastrointestinal haemorrhage, is the most frequent cause of gastrointestinal bleeding and is a common presentation in emergency departments. Medical treatment based on the use of proton pump inhibitors (PPIs), together with endoscopic therapy, has been shown to significantly lower rates of rebleeding and improve survival in these patients. Two decades after the marketing of PPIs there is still controversy as to dosage and method of administration for patients with gastrointestinal bleeding of peptic origin (AU)