Endoscopic Repair of an Iatrogenic Perforation During Gastric Endoscopic Submucosal Dissection

AbstractPerforation is a severe complication of endoscopic submucosal dissection (ESD), and the incidence is reported to be 2–6%. Appropriate endoscopic repair should be administered immediately to prevent severe complications. As a first step, it is very useful to create a neoplasia-free area around the edges of the perforation with a dual knife. Then this area can be safely closed with endoclips. During the procedure, it is strongly advisable to use CO2 insufflation instead of air to reduce abdominal discomfort. Here, this method is demonstrated in a case with a large perforation that occurred during the ESD procedure. This article is part of an expert video encyclopedia

Replica symmetry breaking transition of the weakly anisotropic Heisenberg spin glass in magnetic fields

The spin and the chirality orderings of the three-dimensional Heisenberg spin glass with the weak random anisotropy are studied under applied magnetic fields by equilibrium Monte Carlo simulations. A replica symmetry breaking transition occurs in the chiral sector accompanied by the simultaneous spin-glass order. The ordering behavior differs significantly from that of the Ising SG, despite the similarity in the global symmetry. Our observation is consistent with the spin-chirality decoupling-recoupling scenario of a spin-glass transition.Comment: 4 pages, 4 figure

Management of an Accessory Bile Duct Leak Following Pancreaticoduodenectomy: A Novel Approach Utilizing a Percutaneous and Endoscopic Rendezvous.

Biliary leaks are uncommon but morbid complications of pancreaticoduodenectomies, which have historically been managed with percutaneous drainage, reoperation, or a combination of both. We report a de novo percutaneous-endoscopic hepaticojejunostomy from an anomalous right hepatic duct injured during pancreaticoduodenectomy to the afferent bowel limb. The percutaneous-endoscopic hepaticojejunostomy was stented to allow for tract formation with successful stent removal after 5.5 months. One year after the creation of the percutaneous-endoscopic hepaticojejunostomy, the patient remains clinically well without evidence of biliary leak or obstruction

Fulminant Type 1 Diabetes as a Model of Nature to Explore the Role of C-Peptide

Patients with fulminant type 1 diabetes almost completely lack C-peptide even soon after the onset of the disease, and the deficiency continues for the rest of their life. Thus, fulminant type 1 diabetes could serve as a good model of nature to explore the physiological role of C-peptide. For example, patients with fulminant type 1 diabetes have diabetic chronic complications more frequently than those with classical autoimmune type 1 diabetes 5 years after the onset of diabetes, and the higher prevalence could be partly attributable to the complete lack of C-peptide in fulminant type 1 diabetes