Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines

The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspiration (PTGBA) is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. To clarify the clinical value of these drainage methods, proper randomized trials should be done. This article describes techniques of drainage for acute cholecystitis

Syndromes with congenital brittle bones

BACKGROUND: There is no clear definition of osteogenesis imperfecta (OI). The most widely used classification of OI divides the disease in four types, although it has been suggested that there may be at least 12 forms of OI. These forms have been named with numbers, eponyms or descriptive names. Some of these syndromes can actually be considered congenital forms of brittle bones resembling OI (SROI). DISCUSSION: A review of different syndromes with congenital brittle bones published in the literature is presented. Syndromes are classified in "OI" (those secondary to mutations in the type I pro-collagen genes), and "syndromes resembling OI" (those secondary to mutations other that the type I pro-collagen genes, identified or not). A definition for OI is proposed as a syndrome of congenital brittle bones secondary to mutations in the genes codifying for pro-collagen genes (COL1A1 and COL1A2). SUMMARY: A debate about the definition of OI and a possible clinical and prognostic classification are warranted

Endoscopic submucosal dissection using water jet short needle knives (Flush knife) for the treatment of gastrointestinal epithelial neoplasms

Nous avons mis au point des bistouris à aiguille courte capables d’émettre un jet d’eau à l’extrémité de la gaine (Flush-knife) afin de réaliser des dissections sous-muqueuses endoscopiques (DSE) avec plus de facilité, de sécurité et d’efficacité. Le raccourcissement de l’extrémité du bistouri à aiguille permet un marquage très fin, une incision de la muqueuse et une dissection de la sous-muqueuse faciles et sûres. L’émission d’un jet d’eau à partir de l’extrémité du cathéter permet le lavage du champ visuel, la mise en évidence des sites hémorragiques et en outre, l’injection locale sous-muqueuse sans remplacement des instruments opératoires et ceci grâce au bistouri, permettant ainsi un traitement très efficace. Le flush-knife peut être considéré comme un des instruments opératoires utiles dans le cadre de la DSE