Isotretinoin and inflammatory bowel disease

[Excerpt] We read with great interest the recent review published in your Journal by Reddy et al., which suggests a possible association between isotretinoin use and inflammatory bowel disease (IBD) (1). Although IBD is described as a possible adverse drug reaction in the product information, little attention has been given in the literature to this association.[...

Emergencies after endoscopic procedures

Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation

Transvesical endoscopic peritoneoscopy: intra-abdominal scarless surgery for urologic applications

For many abdominal procedures, advantages such as minimal scarring, reduced pain, and faster recovery have made laparoscopy the favored approach over traditional open surgery. The most recent minimally invasive approach is natural orifice transluminal endoscopic surgery (NOTES), which limits morbidity because this surgery does not require incision. This article reviews the history, development, and current and future applications of NOTES in the field of urology

Transumbilical Videolaparoscopic Cholecystectomy (Single Site) With Standart Laparoscopyc Instruments

artigo intitulado Colecistectomia videolaparoscópica transumbilical (single site) com equipamento de laparoscopia convencional recentemente publicado por Alves Júnior e colaboradores mereceu-nos atenção e algumas considerações que gostaria de partilhar. Embora aborde uma temática tradicionalmente adstrita à Cirurgia Geral, vale a pena revisitar alguns conceitos e perceber o contexto actual da cirurgia minimamente invasiva (MIS), onde também temos lugar enquanto gastrenterologistas

Response.

Response: Luís Lopes, MD, PhD Mário Dinis-Ribeiro, MD, PhD Carla Rolanda, MD, PhD Show more doi:10.1016/j.gie.2015.01.001 Refers To: Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Christos Zavos, Jannis Kountouras The endoscopic morphology of major papillae influences the selected precut technique for biliary access Gastrointestinal Endoscopy, Volume 81, Issue 4, April 2015, Page 105

Transvesical route for NOTES urological applications: advances & controversies

Natural Orifice Transluminal Endoscopic Surgery (NOTES) has emerged recently in the experimental surgical field, innovating for the passage of luminal barrier, the absence of scars and reduction of post-operative pain. Among the various ports of access (transvaginal, transgastric, transvesical and transcolonic), this paper is an update on advances & controversies of transvesical port for NOTES Urological applications

Digital rectal examination and balloon expulsion test in the study of defecatory disorders: are they suitable as screening or excluding tests?

Background. Rome III criteria add physiological criteria to symptom-based criteria of chronic constipation (CC) for the diagnosis of defecatory disorders (DD). However, a gold-standard test is still lacking and physiological examination is expensive and timeconsuming. Aim. Evaluate the usefulness of two low-cost tests-digital rectal examination (DRE) and balloon expulsion test (BET)-as screening or excluding tests ofDD. Methods. Weperformeda systematic search inPUBMEDandMEDLINE. We selected studies where constipated patients were evaluated by DRE or BET. Heterogeneity was assessed and random effect models were used to calculate the sensitivity, specificity, and negative predictive value (NPV) of the DRE and the BET. Results. Thirteen studies evaluating BET and four studies evaluating DRE (2329 patients) were selected. High heterogeneity (.. 2 > 80%) among studies was demonstrated. The studies evaluating the BET showed a sensitivity and specificity of 67% and 80%, respectively. Regarding the DRE, a sensitivity of 80% and specificity of 84% were calculated. NPV of 72% for the BET and NPV of 64% for the DRE were estimated. The sensitivity and specificity were similar when we restrict the analysis to studies using Rome criteria to define CC. The BET seems to performbetter when a cut-off time of 2minutes is used and when it is compared with a combination of physiological tests. Considering the DRE, strict criteria seem to improve the sensitivity but not the specificity of the test. Conclusion. Neither of the low-cost tests seems suitable for screening or excluding DD.info:eu-repo/semantics/publishedVersio

TRANSESOPHAGEAL RIGHT UPPER PULMONARY LOBECTOMY - IN VIVO PORCINE EXPERIMENTAL STUDY

TRANSESOPHAGEAL RIGHT UPPER PULMONARY LOBECTOMY - IN VIVO PORCINE EXPERIMENTAL STUDY João Moreira-Pinto, MD1,2,3; Aníbal Ferreira, MD1,2,4; Alice Miranda, DVM1,2; Carla Rolanda, MD, PhD1,2,4; Jorge Correia-Pinto, MD, PhD1,2,5 1Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; 2ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal; 3Pediatric Surgery division, Centro Hospitalar do Porto, Porto, Portugal; 4Department of Gastroenterology, Hospital de Braga, Braga, Portugal; 5Pediatric Surgery division, Hospital de Braga, Braga, Portugal. Background and Study Aims Video-assisted thoracoscopic surgery (VATS) has been widespread as the better approach to carry out pulmonary lobectomy. Natural Orifice Transluminal Endoscopic Surgery (NOTES) is being assessed as an alternative to the transthoracic endoscopic surgery. We designed this study to test the feasibility of peroral transesophageal right upper pulmonary lobectomy with the assistance of a single transthoracic trocar. Material and Methods In ten anesthetized pigs (35-45 Kg), we performed right upper pulmonary lobectomy using a forward viewing single-channel gastroscope (introduced perorally) and an operative thoracoscope with a 5 mm working channel (introduced through a single-transthoracic 10 mm port) (Karl Storz). After introducing the gastroscope throughout an oroesophageal overtube into the esophagus, a 1 cm transverse esophagotomy was carried out in the upper third using an ESD-knife under thoracoscope control. Anatomic dissection of the right upper hilum was performed using flexible (gastroscope) and rigid (thoracoscope) instruments. After individual dissection, right upper pulmonary arteries, veins and correspondent bronchus were independently stapled using a 45-mm long, linear endostapler (EndoPath®, Ethicon Endo-Surgery) introduced through the oroesophageal overtube. After completing the lobe resection using an endoscopic snare with cautery, the specimen was extracted retrogradely through the mouth. The esophagotomy was stitched and tied using Endo Stitch™ (Covidien) and a long knot-pusher, which were handled through the oroesophageal overtube. Results Esophagotomy was performed safely in all animals. Dissection of the right upper lobe hilum elements (arteries, veins and bronchus) was also carried out in all animals without significant problems. Oroesophageal handling of the endostapplers for independent ligation of the hilum elements under transthoracic imaging was surprisingly feasible, reasonably easy to perform and reliable in 7 cases. In two cases ligation of the vessels was en bloc. In one case, severe hemorrhage occurred from incomplete vein ligation, although we could control it using electrocoagulation. Esophagotomy closure was feasible but its reliability was not tested in survival studies. All but one animal were kept alive until the end of the acute experiment when they were sacrificed. Conclusions Transesophageal right upper pulmonary lobectomy using single transthoracic trocar assistance is feasible and it may represent a step towards scarless pulmonary lobectomy. Additional survival studies are necessary to test the reliability of this procedure. Apresentador: João Moreira-Pinto, Médico Interno de Cirurgia Pediátrica, CHP