Еволюція історичних уявлень про Україну в середньовічній Франції до середини ХVІІ ст.

У статті розглянуто стан ознайомлення французької громадськості ХІ-ХVІІ ст. з Україною, проаналізовано причини цікавості французів до цієї країни на тлі історичних взаємин України та Франції. Автор простежує еволюцію французьких історичних досліджень про Україну у Франції.The author considers the state of acquaintance of the French society of the XVII century with Ukraine, analyses the reasons of the interest the French took in this country on the phone of the historical relations between Ukraine and France and traces the evolution of the French historical studies in Ukraine

Management of patients with T1b esophageal adenocarcinoma: a retrospective cohort study on patient management and risk of metastatic disease

Esophagectomy for submucosal (T1b) esophageal adenocarcinoma (EAC) is performed in order to optimize patient outcomes given the risk of concurrent lymph node metastases (LNM). However, not seldom, comorbidity precludes these patients from surgery. Therefore, the aim of our study was to assess the course of follow-up after treatment in submucosal EAC patients undergoing surgery versus conservative therapy and to evaluate the incidence of metastatic disease. Between 2001 and 2012, all patients undergoing diagnostic endoscopic resection for EAC in two centers were reviewed. Only patients with histopathologically proven submucosal tumor invasion were included. Submucosal EACs were divided into tumors that were removed radically (R0) and irradically (R1). Subsequently, in the R0 group, EACs were classified as either low risk (LR; submucosal invasion 500 nm, G3-G4 and/or LVI). Metastatic disease was defined as LNM in surgical resection specimen and/or evidence of malignant disease during follow-up (FU). Sixty-nine patients with a submucosal EAC were included [23 R1-resections and 46 R0-resection (14 R0-LR and 32 R0-HR)]. Twenty-six patients underwent surgical treatment (1 R0-LR, 12 R0-HR and 13 R1). None of the 14 R0-LR patients developed metastatic disease after a median FU of 60 months. In the R0-HR group and R1 group, metastatic disease was diagnosed in 16 and 30 % of patients, respectively. Surgical patients tended to have a better overall survival than non-surgical patients (p = 0.09). Tumor-related deaths, however, were 12 % in both groups. In LR submucosal EAC, the risk of metastatic disease appears to be very low. In deep submucosal EAC (either R0- or R1-resection), the rate of metastatic disease is lower than reported in earlier surgical series. Given the reasonable disease-free survival and high background mortality, conservative management of these patients seems to be a valid alternative for surgery in selected case

The Efficacy of an Endoscopic Grasp-and-Traction Device for Gastric Endoscopic Submucosal Dissection: An Ex Vivo Comparative Study (with Video)

To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD). Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL-) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed. En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm(2) vs. 0.91 min/cm(2)), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm(2) vs. 1.01 [EL-] min/cm(2), p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL-) min/cm(2) (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm(2) vs. 0.38 [EL-] min/cm(2), p=0.03). In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be exclude

Detection of lesions in dysplastic Barrett's esophagus by community and expert endoscopists

Background and aims Endoscopic treatment of Barrett's esophagus (BE) consists of endoscopic resection of visible lesions followed by radiofrequency ablation (RFA) for any remaining flat BE. Because RFA is only justified in flat BE, detection of neoplastic lesions (high grade dysplasia [HGD] and early adenocarcinoma [EAC]) is crucial. We hypothesized that the detection of visible lesions containing HGD or EAC would be superior in BE expert centers compared with community hospitals, thereby supporting centralization of therapy for BE-related neoplasia. Methods Patients referred with histologically proven HGD or EAC to two Dutch BE expert centers were included. Referral letters, and endoscopy and pathology reports were reviewed for the description of the BE, presence of lesions, and histopathological analysis of target and random tissue sampling. Primary outcome was the endoscopic detection rate of lesions containing histopathologically proven neoplasia (HGD and/or EAC) in community and expert centers. Results There were 198 patients referred from 37 community hospitals (median referral time 55 days [interquartile range 33 - 85]). Detection rates for visible lesions were 60% in community centers (75% in patients with a biopsy diagnosis of EAC, 47% in HGD) and 87% in expert centers (98% in EAC, 75% in HGD); P <0.001. Even with HGD/EAC on random biopsies from the index endoscopy, the yield at repeat endoscopy was <50% in community hospitals. In 79 patients referred solely because of random biopsy results, a lesion requiring endoscopic resection or surgery was found in 76% by the expert endoscopists. Conclusions Endoscopists at community hospitals detect neoplastic lesions at a significantly lower rate. These data support the value of BE expert centers for work-up and further treatment of B

Efficacy of the CryoBalloon Focal Ablation System for the eradication of dysplastic Barrett's esophagus islands

Background and study aim Cryoablation can be used for the treatment of Barrett's esophagus (BE). A recent dosimetry study, using the CryoBalloon Focal Ablation System (CryoBalloon), demonstrated that 10-second ablations result in complete eradication of BE. However, the efficacy of 10-second ablation in a larger cohort of patients has not been investigated, nor has the potential of precise targeting of specific areas. The aim of the study was to assess the efficacy and performance (i.e. targeting of BE islands) of a 10-second cryoablation using the CryoBalloon. Results A total of 30 patients were enrolled (worst pathology: low grade dysplasia in 14 [47%], high grade dysplasia in 7 [23 %], early adenocarcinoma in 9 [30%]). Of the 47 BE islands, 44 (94%) were adequately targeted. Complete eradication of intestinal metaplasia and dysplasia was observed in 100% of the completely ablated areas. No stenoses were observed. Conclusion Cryoablation of BE islands using the CryoBalloon is effective. BE islands were effectively targete

Simplified protocol for focal radiofrequency ablation using the HALO90 device: short-term efficacy and safety in patients with dysplastic Barrett's esophagus

The standard protocol for focal radiofrequency ablation (RFA) of Barrett's esophagus comprises two applications of radiofrequency energy, cleaning of the ablated areas and catheter, and two further applications (2 × 15 J/cm(2) - cleaning - 2 × 15 J/cm(2)). A simplified protocol (3 × 15 J/cm(2), no cleaning) proved noninferior to standard protocol for individual islands of Barrett's esophagus, but may be associated with higher stenosis rates when applied circumferentially and sequentially over time. We evaluated the efficacy and safety of the above mentioned simplified protocol. Barrett's esophagus patients undergoing focal RFA using the simplified protocol in four tertiary referral centers were retrospectively included. During each focal ablation, the gastroesophageal junction (GEJ) was ablated circumferentially in addition to Barrett's esophagus islands or tongues. Sessions continued at 8 to 12-week intervals until complete resolution of Barrett's esophagus. Primary outcome parameters comprised complete remission of dysplasia and of intestinal metaplasia, and stenosis requiring dilation. 83 patients with dysplastic Barrett's esophagus (median Prague classification C1M3) were enrolled; 66/83 (80 %) had endoscopic resection of a visible lesion before RFA. Intention-to-treat analysis showed complete remission of dysplasia in 78/83 (94 %) and of intestinal metaplasia in 72/83 (87 %). Stenosis requiring dilation developed in 9/83 (11 %), necessitating a median 2 dilation sessions (range 1 - 9), with ≥ 8 sessions in three patients. A treatment algorithm incorporating the simplified protocol of 3 × 15 J/cm(2), with no cleaning, for all focal RFA sessions, appears effective. The associated number and severity of stenoses, however, raises safety concern