38 research outputs found
Diagnostic performance and factors influencing the accuracy of EUS-FNA of pancreatic neuroendocrine neoplasms
The Messinian Salinity Crisis Record in the Palma basin (Mallorca, Balearic Islands)
El registro estratigr谩fico del Messiniense y Plioceno de la cuenca de
Palma (Mallorca) muestra cuatro unidades estratigr谩ficas y dos superficies de
discontinuidad importantes. La Unidad Arrecifal (Tortoniense superior-Messiniense)
registra la sedimentaci贸n marina pre-evapor铆tica (dep贸sitos precrisis).
Esta unidad se encuentra limitada a techo por la superficie de discontinuidad
intra-Messiniense, representando una fase erosiva suba茅rea relacionada
con una primera gran ca铆da del nivel del mar. El episodio evapor铆tico
marginal est谩 representado por el Complejo Carbon谩tico Terminal evolucionando
lateralmente a yesos selen铆ticos masivos hacia el centro de
cuenca. Los dep贸sitos post-evapor铆ticos (Messiniense final) est谩n representados
por una sedimentaci贸n 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
ca铆da importante del nivel del Mar. Sobre esta 煤ltima discontinuidad
se disponen las unidades pliocenas, representadas por dep贸sitos 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
Updates of pancreatic neuroendocrine neoplasm in the 2017 World Health Organization classification
Endoscopic retrieval of a surgical gauze from the right colon Extracci贸n endosc贸pica de gasa quir煤rgica en colon derecho
Usefulness of endoscopic ultrasonography (EUS) for selecting carcinoid tumors as candidates to endoscopic resection Utilidad de la ultrasonograf铆a endosc贸pica (USE) para seleccionar tumores carcinoides como candidatos a una resecci贸n endosc贸pica
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).Introducci贸n: los tumores carcinoides (TC) son los tumores neuroendocrinos (TNEs) m谩s frecuentes. Los TC digestivos localizados en el tracto gastroduodenal y rectocol贸nico pueden ser evaluados por endoscopia y por ecoendoscopia o ultrasonograf铆a endosc贸pica (USE), con el objetivo de efectuar una resecci贸n local como tratamiento curativo sin recurrir a la cirug铆a. Objetivo: los objetivos finales de este estudio fueron: - Analizar si es 煤til la USE en la selecci贸n de TC como candidatos a una extirpaci贸n endosc贸pica. - La evaluaci贸n de la eficacia de la resecci贸n local (resecci贸n completa del carcinoide) y la seguridad (complicaciones) de la t茅cnica efectuada. Pacientes y m茅todos: 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 a帽os (media: 57 a帽os), con tumores carcinoides digestivos biopsiados y tratados endosc贸picamente, con estudio previo de extensi贸n negativo. Se resecaron 21 tumores de 2 a 20 mm (tama帽o medio: 8 mm), en 23 procedimientos. Despu茅s de endoscopia m谩s biopsia y ecoendoscopia (USE), se llev贸 a cabo la extirpaci贸n mediante mucosectom铆a con asa de polipectom铆a convencional e inyecci贸n submucosa con suero salino y/o adrenalina en la mayor铆a de casos (15) y en seis con t茅cnica de mucosectom铆a tras ligar la lesi贸n con bandas el谩sticas. En dos casos con cirug铆a endosc贸pica transanal (TEM) (uno despu茅s de haber efectuado polipectom铆a no curativa). Se efectuaron en total 23 tratamientos localizados con el objetivo fundamental de evaluar la eficacia (resecci贸n completa: RC) y seguridad (complicaciones). Resultados: no hubo complicaciones muy importantes, excepto en la 煤ltima mucosectom铆a g谩strica por un carcinoide de 6 mm, en la que se produjo una miniperforaci贸n (1/23: 4,3%) que se resolvi贸 con la colocaci贸n de 3 clips. La sensibilidad de la USE fue del 94%. La resecci贸n completa fue del 90,5% (19/21). Conclusiones: la resecci贸n mucosa endosc贸pica de tumores carcinoides seleccionados es una t茅cnica segura y eficaz. La USE es la t茅cnica de elecci贸n para seleccionar los pacientes candidatos a resecci贸n endosc贸pica (carcinoides menores de 20 mm situados en las primeras capas, con muscular propia indemne y con estudio de extensi贸n 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庐 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 卤 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