Two en bloc circumferential endoscopic resections of synchronous esophageal neoplasms: a reality even in the West

Abstract Background The feasibility and safety of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms extending to the cervical esophagus currently remain unknown because of the limited number of cases. We aimed to clarify the clinical outcomes of these cases. Methods This was a case series study conducted at a single institution that enrolled 26 consecutive patients with superficial esophageal neoplasms extending to the cervical esophagus who underwent ESD between July 2003 and December 2015. Results En bloc and complete resection rates were both 100 % and no major intraprocedural complications occurred. Thirteen patients were treated with prophylactic steroid therapy. The incidence of postoperative stricture in patients with a circumferential mucosal defect of more than three-quarters was 72.7 %. Four patients required entire circumferential resection, with perforation occurring after endoscopic balloon dilation (EBD) in two and EBD being required for more than 1 year in the other two. Conclusions ESD including the cervical esophagus is technically feasible. Circumferential resection may cause refractory postoperative stricture or post-EBD perforation, so needs to be avoided where possible.

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Subcutaneous B Cell Lymphoma in a Dog from the West Indies

Case Reports in Veterinary Medicine ◽

10.1155/2020/3695130 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Brittany Cortina ◽

Emily Guenthner ◽

Lara Sypniewski

Keyword(s):

B Cell ◽

West Indies ◽

Cell Lymphoma ◽

Oral Prednisone ◽

Tumor Resection ◽

B Cell Lymphoma ◽

Skin Lesions ◽

The West ◽

En Bloc ◽

The Right

A 9-year-old male castrated mixed-breed dog from the West Indies was presented for multiple, nonpainful, nodular, circumscribed, subcutaneous masses located on the dorsum, lateral thorax, head, forelimbs, and scrotum. En bloc surgical resection of a mass on the right paw, left forehead, and left medial forelimb with proportional margins was performed. Three punch biopsies were taken from the masses located along the right lateral flank. Histopathologic and immunohistochemistry (IHC) examination of the skin lesions revealed a diagnosis of subcutaneous B cell lymphoma. Thoracic radiographs and abdominal ultrasound were negative for signs of gross metastatic disease. Chemotherapeutic intervention included intravenous doxorubicin (30 mg/m2) administered at 3-week intervals for 3 treatments and oral prednisone (2 mg/kg/d) for 3 weeks. There were no complications following the chemotherapy protocol. As of 3 years, there has been no regrowth of the tumors and the patient continues to be cancer free. To date, this is the first reported case of subcutaneous B cell lymphoma diagnosed in a dog treated successfully with gross tumor resection and chemotherapy.

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IS ENDOSCOPIC SUBMUCOSAL DISSECTION STILL LIMITED TO FEW TERTIARY CENTERS IN THE WEST? RESULTS FROM A NATIONAL SURVEY IN BRAZIL

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.202000000-84 ◽

2020 ◽

Vol 57 (4) ◽

pp. 477-483

Author(s):

Vitor N ARANTES ◽

Maria das Graças Pimenta SANNA ◽

Jairo Silva ALVES ◽

Daniela Medeiros MILHOMEM-CARDOSO ◽

Fauze MALUF-FILHO

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

The West ◽

En Bloc ◽

Electronic Survey ◽

Additional Information ◽

Submucosal Dissection ◽

Hands On ◽

En Bloc Excision ◽

Bloc Excision

ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) enables en bloc excision of superficial neoplasms. Although ESD is widely practiced in Eastern countries like Japan, South Korea and China, its use in the West is supposed to be still limited to few tertiary centers. OBJECTIVE: This study aimed to investigate the clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Brazilian Society of Digestive Endoscopy (SOBED). METHODS: In October 2019, 3512 endoscopist members of SOBED were invited to respond to an electronic survey containing 40 questions divided into four topics: operator profile; clinical experience with ESD; adverse events and training. Informed consent was requested to all participants. The investigators reviewed all responses and considered valid if more than 50% of the questions were answered and additional information, when requested, was provided. RESULTS: A total of 155 (4.4%) qualified responses entered the study. ESD has been practiced in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of practice. ESD has been performed more frequently in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD was performed mainly in the stomach (72%), followed by the rectum (57%) and 80% of the individuals reported less than 25 operations. Twenty-four (15.4 %) individuals reported perforation and 4 (2.5%) of them reported postoperative deaths. Approximately a quarter of responders denied hands-on training in models or visit to training centers. CONCLUSION: ESD appears to be practiced throughout the country, not only in tertiary or academic institutions and mainly in private practice. Most operators received limited training and still are at the beginning of their learning curve. The reported adverse events and mortality rates appear to be higher than Eastern reports.

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Su1528 Beyond the Snare: Technically Accessible Large En Bloc Colonic Resection in the West

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.03.582 ◽

2011 ◽

Vol 73 (4) ◽

pp. AB294

Author(s):

Alan Moss ◽

Michael J. Bourke ◽

Andrew J. Metz ◽

Duncan McLeod ◽

Kayla Tran ◽

...

Keyword(s):

Colonic Resection ◽

The West ◽

En Bloc

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Water and American Government: The Reclamation Bureau, National Water Policy, and the West, 19021935. By Donald J. Pisani. Berkeley: University of California Press, 2002. Pp. xviii, 394. $49.95.

The Journal of Economic History ◽

10.1017/s0022050703542322 ◽

2003 ◽

Vol 63 (3) ◽

pp. 906-908

Author(s):

MARK KANAZAWA

Keyword(s):

Water Policy ◽

University Of California ◽

American Government ◽

The West ◽

National Water

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Platinum Compounds as Stains for Electron Microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100051165 ◽

1974 ◽

Vol 32 ◽

pp. 230-231

Author(s):

S. K. Aggarwal ◽

P. McAllister ◽

R. W. Wagner ◽

B. Rosenberg

Keyword(s):

Electron Microscopy ◽

Hela Cells ◽

Uranyl Acetate ◽

Sarcoma 180 ◽

Platinum Compounds ◽

Kb Cells ◽

En Bloc ◽

Human Lymphoma ◽

Ultrathin Sections ◽

Blue Coloration

Uranyl acetate has been used as an electron stain for en bloc staining as well as for staining ultrathin sections in conjunction with various lead stains (Fig. 1). Present studies reveal that various platinum compounds also show promise as electron stains. Certain platinum compounds have been shown to be effective anti-tumor agents. Of particular interest are the compounds with either uracil or thymine as one of the ligands (cis-Pt(II)-uracil; cis-Pt(II)-thymine). These compounds are amorphous, highly soluble in water and often exhibit an intense blue coloration. These compounds show enough electron density to be used as stains for electron microscopy. Most of the studies are based on various cell lines (human AV, cells, human lymphoma cells, KB cells, Sarcoma-180 ascites cells, chick fibroblasts and HeLa cells) while studies on tissue blocks are in progress.

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Cellular Contacts Within the Interhemal Membrane of the Rat Placenta at Term

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100050743 ◽

1974 ◽

Vol 32 ◽

pp. 146-147

Author(s):

William P. Jollie

Keyword(s):

Osmium Tetroxide ◽

Uranyl Acetate ◽

Capillary Endothelium ◽

En Bloc ◽

Aldehyde Fixation ◽

Chorioallantoic Placenta

By routine EM preparative techniques, the tissues which, collectively, separate maternal and fetal bloods in the fully formed chorioallantoic placenta of the rat have been shown to consist of three chorionic layers, or trophoblast, and a layer of allantoic capillary endothelium [Fig. 1]. Relationships between these layers are best demonstrated by special techniques, viz., cacodylate-buffered aldehyde fixation, collidine-buffered osmium tetroxide postfixation, and en bloc staining with uranyl acetate. By using this method on placentas at term, the cells of the outermost chorionic layer (Trophoblast 1) appear to be attached to each other by means of maculae adherentes which sometimes occur in clusters [Fig. 2].

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Localization of pancreatic enzymes in ultrathin frozen sections stained with metal labeled antibody

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100081310 ◽

1978 ◽

Vol 36 (2) ◽

pp. 90-91

Author(s):

Kenjiro Yasuda

Keyword(s):

Fluorescent Antibody ◽

Pancreatic Enzymes ◽

Tissue Preparation ◽

Zymogen Granules ◽

Frozen Sections ◽

En Bloc ◽

Antibody Method ◽

Ultrathin Frozen Sections ◽

Fluorescent Antibody Method

Localization of amylase,chymotrypsinogen and trypsinogen in pancreas was demonstrated by Yasuda and Coons (1966), by using fluorescent antibody method. These enzymes were naturally found in the zymogen granules. Among them, amylase showed a diffuse localization around the nucleus, in addition to the zymogen granules. Using ferritin antibody method, scattered ferritin granules were also found around the Golgi area (Yasuda et al.,1967). The recent advance in the tissue preparation enables the antigen to be localized in the ultrathin frozen sections, by applying the labeled antibodies onto the sections instead of staining the tissue en bloc.The present study deals with the comparison of the localization of amylase and lipase demonstrated by applying the bismuth-labeled, peroxidase-labeled and ferritin-labeled antibody methods on the ultrathin frozen sections of pancreas, and on the blocks of the same tissue.

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