The Messinian Salinity Crisis Record in the Palma basin (Mallorca, Balearic Islands)

El registro estratigráfico del Messiniense y Plioceno de la cuenca de Palma (Mallorca) muestra cuatro unidades estratigráficas y dos superficies de discontinuidad importantes. La Unidad Arrecifal (Tortoniense superior-Messiniense) registra la sedimentación marina pre-evaporítica (depósitos precrisis). Esta unidad se encuentra limitada a techo por la superficie de discontinuidad intra-Messiniense, representando una fase erosiva subaérea relacionada con una primera gran caída del nivel del mar. El episodio evaporítico marginal está representado por el Complejo Carbonático Terminal evolucionando lateralmente a yesos seleníticos masivos hacia el centro de cuenca. Los depósitos post-evaporíticos (Messiniense final) están representados por una sedimentación lacustre-continental relacionada con el denominado episodio Lago-Mare. A techo de esta Unidad Lago-Mare se localiza una superficie de discontinuidad fini-Messiniense, consecuencia de una segunda caída importante del nivel del Mar. Sobre esta última discontinuidad se disponen las unidades pliocenas, representadas por depósitos marinos transgresivos que marcan el final de la Crisis de Salinidad del MessinienseThe Messinian and Pliocene stratigraphic record in the Palma basin (Mallorca) shows four stratigraphic units and two majors unconformities.The Reef Unit (late Tortonian-Messinian) recorded the pre-evaporitic marine sedimentation (pre-Messinian Salinity Crisis). This unit is limited at the top by the intra-Messinian unconformity, representing a subaerial erosive phase related to a first major sea-level fall. The evaporitic marginal episode is characterized by the Terminal Carbonate Complex changing basinward into massive selenite gypsum.The post-evaporitic deposits (latest Messinian) are characterized by lacustrine-continental sedimentation, related to the so called Lago Mare episode. At the top of the Lago-Mare Unit is located the fini- Messinian unconformity, caused by a second major sea-level fall. Over this unconformity lies the Pliocene Units (early Pliocene), represented by marine deposit which marks a transgression, and the subsequent final of the Messinian Salinity Crisi

Usefulness of endoscopic ultrasonography (EUS) for selecting carcinoid tumors as candidates to endoscopic resection Utilidad de la ultrasonografía endoscópica (USE) para seleccionar tumores carcinoides como candidatos a una resección endoscópica

Introduction: carcinoid tumors (CTs) represent the most common type of neuroendocrine tumors (NETs). Digestive CTs in the gastroduodenal and colorectal tracts may be assessed using endoscopy and echoendoscopy or endoscopic ultrasonography (EUS) with the goal of attempting local resection with curative intent without having recourse to surgery. Objective: endpoints in this study included: - Assessing the usefulness of EUS for selecting CTs as candidates to endoscopic excision. - Assessing the effectiveness of local resection (complete carcinoid resection) and the safety (complications) of the technique involved. Patients and methods: our series included 18 patients (12 males and 6 females) with 23 tumors. Sixteen patients (10 males and 6 females) were selected, with age ranging from 40 to 81 years (mean: 57 years), biopsied, endoscopically treated digestive carcinoid tumors, and a previous negative extension study. Twenty-one 2-to-20-mm (mean size 8 mm) tumors were resected in 23 procedures. After endoscopy plus biopsy and echoendoscopy (EUS), excision was carried out with conventional polypectomy snare mucosectomy and submucosal injection with saline and/or adrenaline in most cases (15), and mucosectomy technique following lesion ligation with elastic bands for six cases. Two cases underwent transanal endoscopic surgery (TEM), one of them following non-curative polypectomy. A total of 23 local procedures were performed with the key goal of assessing efficacy (complete resection: CR) and safety (complications). Results: there were no severe complications except for the last gastric mucosectomy for a 6-mm carcinoid, where a miniperforation occurred that was solved by using 3 clips (1/23: 4.3%). EUS sensitivity was 94%. Complete resection was 90.5% (19/21). Conclusions: the endoscopic mucosal resection of selected carcinoid tumors is a safe, effective technique. EUS is the technique of choice to select patients eligible for endoscopic resection (carcinoids smaller than 20 mm in superficial layers, with an unscathed muscularis propria and negative extension study).Introducción: los tumores carcinoides (TC) son los tumores neuroendocrinos (TNEs) más frecuentes. Los TC digestivos localizados en el tracto gastroduodenal y rectocolónico pueden ser evaluados por endoscopia y por ecoendoscopia o ultrasonografía endoscópica (USE), con el objetivo de efectuar una resección local como tratamiento curativo sin recurrir a la cirugía. Objetivo: los objetivos finales de este estudio fueron: - Analizar si es útil la USE en la selección de TC como candidatos a una extirpación endoscópica. - La evaluación de la eficacia de la resección local (resección completa del carcinoide) y la seguridad (complicaciones) de la técnica efectuada. Pacientes y métodos: la serie consta de 18 pacientes (12 varones y 6 mujeres) con 23 tumores. Se han seleccionado 16 pacientes (10 varones y 6 mujeres) con un rango de 40 a 81 años (media: 57 años), con tumores carcinoides digestivos biopsiados y tratados endoscópicamente, con estudio previo de extensión negativo. Se resecaron 21 tumores de 2 a 20 mm (tamaño medio: 8 mm), en 23 procedimientos. Después de endoscopia más biopsia y ecoendoscopia (USE), se llevó a cabo la extirpación mediante mucosectomía con asa de polipectomía convencional e inyección submucosa con suero salino y/o adrenalina en la mayoría de casos (15) y en seis con técnica de mucosectomía tras ligar la lesión con bandas elásticas. En dos casos con cirugía endoscópica transanal (TEM) (uno después de haber efectuado polipectomía no curativa). Se efectuaron en total 23 tratamientos localizados con el objetivo fundamental de evaluar la eficacia (resección completa: RC) y seguridad (complicaciones). Resultados: no hubo complicaciones muy importantes, excepto en la última mucosectomía gástrica por un carcinoide de 6 mm, en la que se produjo una miniperforación (1/23: 4,3%) que se resolvió con la colocación de 3 clips. La sensibilidad de la USE fue del 94%. La resección completa fue del 90,5% (19/21). Conclusiones: la resección mucosa endoscópica de tumores carcinoides seleccionados es una técnica segura y eficaz. La USE es la técnica de elección para seleccionar los pacientes candidatos a resección endoscópica (carcinoides menores de 20 mm situados en las primeras capas, con muscular propia indemne y con estudio de extensión negativo)

Endoscopic band ligation without resection in selected patients for small and superficial upper gastrointestinal tract lesions

Background and aim: The aim of this study was to evaluate the efficacy of endoscopic band ligation (EBL) in carefully selected patients who would benefit from this method of resection. Methods: Patients with early upper gastrointestinal and small (< 15 mm) lesions treated with EBL (Duette® Multi-Band Mucosectomy) were prospectively recruited and retrospectively analyzed between 2010 and 2015. All cases were discussed in a multidisciplinary cancer committee and it was concluded that, owing to patient conditions, surgery was not possible and that not conducting histology would not change the clinical management. A first endoscopic control with biopsies was planned at 4-8 weeks. If there was no persistence of the lesion, new controls were programmed at 6 and 12 months. Results: The group (n = 12) included 5 esophagus lesions (adenosquamous carcinoma, n = 1; carcinoma squamous, n = 2; adenocarcinoma, n = 2); 4 gastric lesions (high grade dysplasia, n = 1; adenocarcinoma, n = 2; neuroendocrine tumor [NET], n = 1), and 3 duodenal lesions (NETs) (n = 3). The mean tumor diameter was 9.6 ± 2.8 mm (range 4-15). Only one minor adverse event was described. At first follow-up (4-8 weeks), there was 91.6% and 75% of endoscopic and histological remission, respectively. At 6-month follow-up there was 70% of both endoscopic remission and negative biopsies. And at 12 months, there was 100% and 75% of endoscopic and histological remission, respectively. Persisting lesions were T1 cancers. The median follow-up was 30.6 months. Conclusion: EBL without resection is an easy and safe technique that should be considered in patients with multiple morbidities and small superficial UGI lesions