Computer-Simulated Biopsy Marking System for Endoscopic Surveillance of Gastric Lesions: A Pilot Study

Endoscopic tattoo with India ink injection for surveillance of premalignant gastric lesions is technically cumbersome and may not be durable. The aim of the study is to evaluate the accuracy of a novel, computer-simulated biopsy marking system (CSBMS) developed for the endoscopic marking of gastric lesions. Twenty-five patients with history of gastric intestinal metaplasia received both CSBMS-guided marking and India ink injection in five points in the stomach at index endoscopy. A second endoscopy was performed at three months. Primary outcome was accuracy of CSBMS (distance between CSBMS probe-guided site and tattoo site measured by CSBMS). The mean accuracy of CSBMS at angularis was5.3±2.2 mm, antral lesser curvature5.7±1.4 mm, antral greater curvature6.1±1.1 mm, antral anterior wall6.9±1.6 mm, and antral posterior wall6.9±1.6 mm. CSBMS (2.3±0.9versus12.5±4.6seconds;P=0.02) required less procedure time compared to endoscopic tattooing. No adverse events were encountered. CSBMS accurately identified previously marked gastric sites by endoscopic tattooing within 1 cm on follow-up endoscopy.

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Standardized pulmonary vein isolation workflow to enclose veins with contiguous lesions: the multicentre VISTAX trial

EP Europace ◽

10.1093/europace/euaa157 ◽

2020 ◽

Vol 22 (11) ◽

pp. 1645-1652

Author(s):

Mattias Duytschaever ◽

Johan Vijgen ◽

Tom De Potter ◽

Daniel Scherr ◽

Hugo Van Herendael ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Randomized Study ◽

Standard Of Care ◽

Posterior Wall ◽

Anterior Wall ◽

Atrial Arrhythmia ◽

Clinical Trial Registration ◽

First Pass

Abstract Aims To evaluate the safety and effectiveness of pulmonary vein isolation in paroxysmal atrial fibrillation (PAF) using a standardized workflow aiming to enclose the veins with contiguous and optimized radiofrequency lesions. Methods and results This multicentre, prospective, non-randomized study was conducted at 17 European sites. Pulmonary vein isolation was guided by VISITAG SURPOINT (VS target ≥550 on the anterior wall; ≥400 on the posterior wall) and intertag distance (≤6 mm). Atrial arrhythmia recurrence was stringently monitored with weekly and symptom-driven transtelephonic monitoring on top of standard-of-care monitoring (24-h Holter and 12-lead electrocardiogram at 3, 6, and 12 months follow-up). Three hundred and forty participants with drug refractory PAF were enrolled. Acute effectiveness (first-pass isolation proof to a 30-min wait period and adenosine challenge) was 82.4% [95% confidence interval (CI) 77.4–86.7%]. At 12-month follow-up, the rate of freedom from any documented atrial arrhythmia was 78.3% (95% CI 73.8–82.8%), while freedom from atrial arrhythmia by standard-of-care monitoring was 89.4% (95% CI 78.8–87.0%). Freedom fromrepeat ablations by the Kaplan–Meier analysis was 90.4% during 12 months of follow-up. Of the 34 patients with repeat ablations, 14 (41.2%) demonstrated full isolation of all pulmonary vein circles. Primary adverse event (PAE) rate was 3.6% (95% CI 1.9–6.3%). Conclusions The VISTAX trial demonstrated that a standardized PAF ablation workflow aiming for contiguous lesions leads to low rates of PAEs, high acute first-pass isolation rates, and 12-month freedom from arrhythmias approaching 80%. Further research is needed to improve the reproducibility of the outcomes across a wider range of centres. Clinical trial registration: ClinicalTrials.gov, number NCT03062046, https://clinicaltrials.gov/ct2/show/NCT03062046.

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External frontal sinusotomy and endoscopic repair of cerebrospinal fluid fistula in the posterior wall: preliminary report of a new technique

The Journal of Laryngology & Otology ◽

10.1017/s0022215111001150 ◽

2011 ◽

Vol 125 (8) ◽

pp. 802-806 ◽

Cited By ~ 6

Author(s):

P Thulasi Das ◽

D Balasubramanian

Keyword(s):

Cerebrospinal Fluid ◽

Frontal Sinus ◽

Posterior Wall ◽

Anterior Wall ◽

New Technique ◽

Endoscopic Repair ◽

Tertiary Referral Centre ◽

Cerebrospinal Fluid Leaks ◽

A New Technique

AbstractIntroduction:Cerebrospinal fluid rhinorrhoea is the abnormal leakage of cerebrospinal fluid into the nasal cavity. The posterior wall of the frontal sinus can be the site of such leakage. Traditionally, these leaks were repaired via external osteoplastic or neurosurgical approaches. Despite advances in instrumentation, it is difficult to manage superiorly or laterally placed defects endoscopically. We present a new technique of endoscopic repair of frontal sinus posterior wall defects, via access holes drilled in the anterior wall of the frontal sinus.Study design:Preliminary study involving patients presenting with frontal sinus cerebrospinal fluid leaks, with defects in the frontal sinus posterior wall, between 2006 and 2010.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patient records were reviewed and analysed.Results:Nine patients underwent external frontal sinusotomy under endoscopic vision. Repair was successful in all cases, with no complications. Follow up ranged from three months to three years.Conclusion:External frontal sinusotomy and endoscopic repair is a simple, precise and cosmetically acceptable alternative to osteoplastic and major neurosurgical techniques for management of frontal sinus posterior wall defects. This new, previously undescribed technique enables otolaryngologists to play a role in managing such defects.

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Calcified Right Ventricular Fibroma in an Adult: A Case Report

10.22541/au.162281012.24531442/v1 ◽

2021 ◽

Author(s):

Huanhuan Gao ◽

Shuai Yuan ◽

Zhiqiang Hu ◽

Zhelan Zheng ◽

Shengjun Wu

Keyword(s):

Right Ventricular ◽

Histopathological Examination ◽

Tumor Resection ◽

Anterior Wall ◽

Benign Tumors ◽

Troublesome Symptom ◽

History Of ◽

The Right ◽

Operative Recovery

Background: Cardiac fibromas are rare benign tumors of the heart composed of fibroblasts and collagen. They are common among children and adolescents but are rarely present in adults. Case presentation: We here report the case of a fifty-seven-year-old man who complaining of a 2-year history of chest tightness at rest. Transthoracic echocardiography detected a severe calcified mass protruding outside the right ventricular anterior wall near the apex. The patient was referred for tumor resection. The calcified mass was determined to be a cardiac fibroma with postoperative histopathological examination. The patient experienced an unremarkable post-operative recovery and was discharged 8 days later. Subsequent follow-up has shown complete freedom from his troublesome symptom. Conclusions: Preoperative diagnosis with various imaging modalities and early surgery are the keys to improve prognosis of patients with cardiac fibromas.

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Immediate and late follow-up results of auto- and alloplastic operations in inguinal hernias

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2020.11-12.48 ◽

2020 ◽

Vol 87 (11-12) ◽

pp. 48-53

Author(s):

Z. T. Shirinov ◽

E. A. Alieva ◽

Z. N. Azadova ◽

N. Kh. Khankishiev

Keyword(s):

Comparative Analysis ◽

Posterior Wall ◽

Late Results ◽

Anterior Wall ◽

Comparative Investigation ◽

Morbidity Rate ◽

Inguinal Hernias ◽

Total Extraperitoneal ◽

Significant Difference

Objective. To conduct a scientific investigation for comparative investigation of results of auto- and allohernioplastic operations. Materials and methods. The investigation was based on analysis of postoperative results in 400 patients, ageing 16 - 85 yrs old, to whom in Scientific Surgical Centre named after Acad. M. A. Topchibashev and the City of Shirvan Central Hospital in 2009-2019 yrs period surgical treatment for inguinal hernia was conducted. Depending on the procedure of hernioplasty applied, the patients were divided into two Groups. In a control one (n=200) the operations were performed, using open autohernioplasty only. In the main Group (n=200) open procedure and laparoscopic allohernioplasty, using different synthetic nets, were applied. Results. Comparative analysis of intraoperative, postoperative immediate and late follow-up results in the patients after auto- and allohernioplasty was done. In accordance to criteria of the intraoperative and immediate postoperative morbidity rate the statistically meaningful differences between two groups of patients were absent. Good late results of allohernioplasty were noted in (71.8 ± 3.41)%, satisfactory - in (17.2 ± 2.86)%, poor - in (11 ± 2.36)% patients (p<0.05); allohernioplasties - accordingly, in (80.2 ± 2.91)%, (16 ± 2.68)% and (3.8 ± 1.39)% patients (p<0.05). Comparative analysis done have shown the statistically much better results of allohernioplasty. Recurrences after allohernioplasty were observed in 3 times less frequently - 3.8%, and after autohernioplasty this index have constituted 11% (p < 0.05). Сomparative analysis of late follow-up results of various autohernioplastic methods have shown good results of Postemskyi method in (76.7 ± 7.72)% patients, and of Postempskyi method in our modification - in (88.9 ± 7.41)% patients. Good results of autoplasty in other methods were noted merely in equal quantity of the patients - in up to 70%, and statistically significant difference was absent. Conclusion. Basing on own results obtained, we recommend to perform autohernioplasty of the inguinal channel anterior wall in accordance to Girard-Sposokukotskyi method with Kimbarovskyi suture for oblique inguinal hernias, while in direct inguinal hernias, for strengthening of posterior wall, - Postempskyi method in our modification. In large and recurrent hernias in patients of middle and senile age it is expedient to apply a Lichtenstein plasty in our modification. Total extraperitoneal or transabdominal preperitoneal plasty is recommended if technical installments needed and the physician’n laparoscopic skills are available.

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The Distribution of Incomplete Gastric Intestinal Metaplasia (GIM) Subtype among Biopsy Sites according to the Updated Sydney System and Its Association with GIM Extension

Gastroenterology Research and Practice ◽

10.1155/2018/4938730 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Duc Trong Quach ◽

Huy Minh Le ◽

Trung Sao Nguyen ◽

Toru Hiyama

Keyword(s):

High Risk ◽

Intestinal Metaplasia ◽

Periodic Acid ◽

Risk Marker ◽

Gastric Intestinal Metaplasia ◽

Biopsy Specimens ◽

Sydney System ◽

Updated Sydney System ◽

Greater Curvature ◽

Lesser Curvature

Background. Current guidelines recommend that extensive gastric intestinal metaplasia (GIM) be considered as a high-risk marker for the development of gastric cancer (GC). But there is emerging evidence that the incomplete GIM subtype is also a high-risk marker. Aims. To evaluate the performance of biopsy sites according to the updated Sydney system on detecting the incomplete GIM subtype and to assess its association with GIM extension. Patients and methods. A cross-sectional study was conducted on 280 Vietnamese patients with nonulcer dyspepsia. Biopsy specimens were taken from gastric sites according to the updated Sydney system, and sections were routinely stained with Giemsa and hematoxylin and eosin. Biopsy specimens with intestinalization were further evaluated for GIM subtypes with alcian blue 2.5 and periodic acid Schiff stainings. Two experienced pathologists jointly examined all the specimens and reached consensus. Results. The rates of patients with GIM and the incomplete GIM subtype were 81 (28.9%) and 24 (8.4%), respectively. There was no GIM in specimens taken from the greater curvature of corpus. The proportions of the incomplete GIM subtype detected at the incisura angularis, lesser curvature of corpus, lesser curvature of antrum, and greater curvature of antrum were 34.3% (12/35), 34.5% (10/29), 40.5% (17/42), and 31.6 (6/19), respectively, which were not significantly different (p=0.89). The presence of an incomplete GIM subtype was associated with multifocal GIM (i.e., ≥3 out of 5 biopsy sites with GIM) (OR=4.02, CI 95%, 1.33–12.16, p=0.022) and extensive GIM (i.e., GIM in specimens from both of corpus and antrum) (OR=2.89, CI 95% 1.04–8.02, p=0.045). Conclusions. The proportions of an incomplete GIM subtype were not significantly different among gastric biopsy sites with intestinalization. The association between an incomplete GIM subtype and GIM extension, therefore, may be due to an sum accumulation effect.

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Surveillance of premalignant gastric lesions: a multicentre prospective cohort study from low incidence regions

Gut ◽

10.1136/gutjnl-2017-314498 ◽

2018 ◽

Vol 68 (4) ◽

pp. 585-593 ◽

Cited By ~ 23

Author(s):

Wouter J den Hollander ◽

I Lisanne Holster ◽

Caroline M den Hoed ◽

Lisette G Capelle ◽

Tjon J Tang ◽

...

Keyword(s):

Gastric Cancer ◽

Intestinal Metaplasia ◽

Diagnostic Yield ◽

Endoscopic Surveillance ◽

High Grade ◽

Neoplastic Progression ◽

Gastric Lesions ◽

Gastric Intestinal Metaplasia ◽

Improve Risk Stratification

ObjectiveInternational guidelines recommend endoscopic surveillance of premalignant gastric lesions. However, the diagnostic yield and preventive effect require further study. We therefore aimed to assess the incidence of neoplastic progression and to assess the ability of various tests to identify patients most at risk for progression.DesignPatients from the Netherlands and Norway with a previous diagnosis of atrophic gastritis (AG), intestinal metaplasia (IM) or dysplasia were offered endoscopic surveillance. All histological specimens were assessed according to the updated Sydney classification and the operative link on gastric intestinal metaplasia (OLGIM) system. In addition, we measured serum pepsinogens (PG) and gastrin-17.Results279 (mean age 57.9 years, SD 11.4, male/female 137/142) patients were included and underwent at least one surveillance endoscopy during follow-up. The mean follow-up time was 57 months (SD 36). Four subjects (1.4%) were diagnosed with high-grade adenoma/dysplasia or invasive neoplasia (ie, gastric cancer) during follow-up. Two of these patients were successfully treated with endoscopic submucosal dissection, while the other two underwent a total gastrectomy. Compared with patients with extended AG/IM (PGI/II≤3 and/or OGLIM stage III–IV), patients with limited AG/IM (PG I/II>3 and OLGIM stage 0–II) did not develop high-grade adenoma/dysplasia or invasive neoplasia during follow-up (p=0.02).ConclusionIn a low gastric cancer incidence area, a surveillance programme can detect gastric cancer at an early curable stage with an overall risk of neoplastic progression of 0.3% per year. Use of serological markers in endoscopic surveillance programmes may improve risk stratification.

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Posterior Wall Collapse in High Myopia following Cataract Surgery

Case Reports in Ophthalmology ◽

10.1159/000487077 ◽

2018 ◽

Vol 9 (1) ◽

pp. 167-171

Author(s):

Galia A. Deitz ◽

Adam R. Sweeney ◽

Hoon C. Jung

Keyword(s):

Cataract Surgery ◽

High Myopia ◽

Posterior Wall ◽

Pathologic Myopia ◽

Uncorrected Distance Visual Acuity ◽

Patient Reported ◽

History Of ◽

Pars Plana ◽

Initial Recovery

Purpose: We report a case of posterior globe collapse of an eye after initial recovery from uncomplicated cataract surgery in a patient with high myopia and discuss the course of management involving recognition and emergent air injection with globe reformation. Case Report: A 64-year-old functionally monocular male with a history of high myopia presented for follow-up after uncomplicated cataract surgery. Uncorrected distance visual acuity (UCDVA) at postoperative day 1 was 20/150 with an intraocular pressure (IOP) of 19 mm Hg. At the week 1 visit, UCDVA had decreased to 20/200 with an IOP at 9 mm Hg. After preliminary exam, the keratome site suture was removed, after which the patient reported vision changes. A dilated fundus exam was performed revealing posterior scleral wall collapse. A clinical diagnosis of hypotony was made and a pars plana injection of 1 mL air was performed. This resulted in immediate subjective improvement of vision. Exam the next day revealed UCDVA 20/50 with pinhole improvement to 20/30 and IOP 15 mm Hg. Conclusion: This case demonstrates postoperative hypotony in a patient with pathologic myopia, following cataract surgery. Pathologically myopic eyes may have greater propensity to collapse in the setting of reduced IOP.

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Imaging Markers of Hip Instability are Associated with Worse Outcomes at Two to Four-year Follow-up in Female Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00427 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0042

Author(s):

Brandy Horton ◽

Hugh West ◽

Jenny Marland ◽

James Wylie

Keyword(s):

Hip Arthroscopy ◽

Acetabular Dysplasia ◽

Posterior Wall ◽

Anterior Wall ◽

Femoral Anteversion ◽

Hip Instability ◽

Female Patients ◽

Imaging Markers ◽

Fear Index

Objectives: To investigate the effect of radiographic markers of hip instability on outcomes of female patients undergoing hip arthroscopy for femoroacetabular impingement. Methods: This was a retrospective reviewof a prospectively collected cohort of females undergoing hip arthroscopy with a diagnosis of FAI treated with femoral osteoplasty with or without labral repair. iHOT-12 was collected preoperatively and at 2 to 4-year follow-up. Radiographs were reviewed and anterior wall index (AWI), posterior wall index (PWI), femoro-epiphyseal acetabular roof (FEAR) index, and lateral center edge angle (LCEA) were recorded in all patients. Computed tomography was used to quantify femoral anteversion in all patients. A laterally oriented FEAR index is considered positive (unstable), while a medially oriented fear index is considered negative (impingement/stable). An AWI of <0.30 and a PWI<0.80 were considered anterior wall deficient (AWD) and posterior wall deficient (PWD), respectively. Patients with borderline acetabular dysplasia (LCEA≤25) were groups as medially or laterally oriented FEAR index. Similarly, patients with borderline acetabular dysplasia(LCEA≤25) were groups as elevated femoral anteversion (>15 degrees) or not. Differences in means were tested using a students t-test or an analysis of variance with a post-hoc tukey’s test. Results: There were 175 Female patients with a mean age of 33 years. Mean follow up was 34.6 months. Mean preoperative iHOT12 was 30.4. Mean postoperative iHOT12 was 74.8. Mean FA was 11.7 (Range 1 to 34) degrees. There were 64 patients with an LCEA≤25, 138 patients had no AWD or PWD, 18 patients with an AWI <0.30 and 18 patients with a PWI <0.80. One patient was excluded from the analysis for having both an AWI<0.30 and a PWI<0.8. Patients with AWD had lower mean iHOT at follow up (54.5 compared with those with no wall deficiency 77.7, p=0.001.) Patents with PWD did not (72.4 compared with those with no wall deficiency 77.7, p=0.669.) Similarly, patients with AWD had lower mean iHOT improvement at follow up (24.2 compared with those with no wall deficiency 47.0, p=0.001). Patents with PWD did not (43.1 compared with those with no wall deficiency 47.0, p=0.808). Mean FEAR index was -7.1(Range -30 to 15) degrees. The FEAR index correlated with both the iHOT12 at follow up (-0.171, p=0.024) and the improvement in the iHOT12(-0.192, p=0.011). There were 31 patients with a laterally oriented FEAR index. These patients had worse iHOT12 at follow-up (64.9 points versus 77.0 points, p=0.037) and less improvement in iHOT12 (34.3 points versus 46.6 points, p=0.015). There were 110 patients with LCEA>25, 42 patients with LCEA≤25 with a medially oriented FEAR index and 23 patients with an LCEA≤25 with a laterally oriented FEAR index. Patients with LCEA≤25 and a laterally oriented FEAR index had worse iHOT12 at follow-up (60.7 points versus 78.9 points, p=0.005) and less improvement in iHOT12 from surgery (30.0 points versus 49.5 points, p=0.002) compared to those with an LCEA>25. There were 110 patients with LCEA>25, 46 patients with LCEA≤25 and FA <15 degrees and 17 patients with LCEA≤25 and FA≥15 degrees. Patients with LCEA≤25 had worse iHOT12 at follow-up (68.0 points versus 78.9 points, p=0.010) and less improvement in iHOT12 from surgery (36.0 points versus 49.5 points, p=0.001) compared to those with an LCEA>25. Patients with LCEA≤25 and FA≥15 degrees had worse iHOT12 at follow-up (59.5 points versus 78.9 points, p=0.008) and less improvement in iHOT12 from surgery (28.2 points versus 49.5 points, p=0.003) compared to those with an LCEA>25. In addition, patients with LCEA≤25 and FA<15 degrees had less improvement iHOT12 from surgery (38.0 points versus 49.4 points, p=0.026) compared to those with an LCEA>25. Conclusion: Imaging markers of hip instability, including borderline acetabular dysplasia, increased femoral anteversion, a laterally oriented FEAR index, and anterior wall deficiency are predictive of worse outcomes of hip arthroscopy for FAI in female patients. A more thoughtful imaging analysis of female patients preoperatively may identify patients at risk of worse outcomes after hip arthroscopy and may guide treatment with other joint preserving procedures, including periacetabular or femoral osteotomy.

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Recurrent Urinary Bladder Paraganglioma

Advances in Urology ◽

10.1155/2010/912125 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3 ◽

Cited By ~ 6

Author(s):

Ali A. Al-Zahrani

Keyword(s):

Case Report ◽

Urinary Bladder ◽

Histological Examination ◽

Bladder Tumor ◽

Imaging Study ◽

Anterior Wall ◽

Partial Cystectomy ◽

Recurrent Lesion ◽

History Of

A 39-year-old male presented with recurrent attacks of painless haematuria. The patient has a history of partial cystectomy for bladder paraganglioma 10 years prior to the presentation. Imaging study and cystoscopic examination revealed a small anterior wall bladder tumor. The histological examination of the lesion confirmed that it was a urinary paraganglioma. Partial cystectomy was performed to this recurrent lesion. This case report stresses the importance of life-long follow-up of these lesions.

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Need for pyloroplasty and vagotomy in case of perforated duodenal ulcer

Herald of Pancreatic Club ◽

10.33149/vkp.2020.01.07 ◽

2020 ◽

Vol 46 (1) ◽

pp. 56-59

Author(s):

V. I. Podoluzhniy ◽

A. B. Startsev ◽

I. A. Radionov

Keyword(s):

Duodenal Ulcer ◽

Surgical Treatment ◽

Gastric Resection ◽

Surgical Intervention ◽

Posterior Wall ◽

Anterior Wall ◽

Ulcer Formation ◽

Perforated Duodenal Ulcer ◽

Selective Proximal Vagotomy ◽

Lesser Curvature

Aim. Estimation of the incidence of stenosis, need for pyloroplasty and validity of vagotomy for perforated duodenal ulcer (PDU). Materials and methods. Twenty-year nature of surgical treatment of patients with PDC in the hospital surgery clinic is analyzed. Results. Over 20 years, 726 patients were operated on: 151 women (20.8%), 575 men (79.2%), mean age 39.1±6.3 years. Surgeries were performed both from laparotomic access and video laparoscopically. It is found that PDU is combined with stenosis in 8.5% and with bleeding in 1.6%, which requires Jadd excision of an ulcer on the anterior wall or gastroduodenotomy for flashing a bleeding ulcer on the posterior wall (0.7%) with subsequent Heineke — Mikulicz pyloroplasty and vagotomy. Both stem vagotomy and selective proximal were used by the method of skeletonization of lesser curvature or chemoneurolysis. Suturing with selective proximal vagotomy was performed in 567 patients, isolated suturing — in 77. B-II distal gastric resection was required in 2.1%. Repeated admission of patients with complications of a duodenal ulcer is observed after isolated suturing of PDU without surgical intervention in the mechanisms of ulcer formation. Conclusion. During surgical treatment of PDU are found in 79.2% of men, in 20.8% of women. There is an emerging stenosis in 8.5% of those who have PDU, which requires a gastric drainage operation. The subjects of choice may be Heineke-Mikulicz pyloroplasty or Jadd excision of an ulcer on the anterior wall. It is advisable to suture or excise an ulcer with pyloroplasty accompanied by vagotomy that normalizes the acid-proteolytic activity of gastric juice in the postoperative period and eliminates need for antisecretory drugs to prevent the recurrence of the disease.

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