다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co

The Clavien-Dindo classification of surgical complications: five-year experience.

CA : A Cancer Journal for Clinicians

The reference human genome sequence set the stage for studies of genetic variation and its association with human disease, but epigenomic studies lack a similar reference. To address this need, the NIH Roadmap Epigenomics Consortium generated the largest collection so far of human epigenomes for primary cells and tissues. Here we describe the integrative analysis of 111 reference human epigenomes generated as part of the programme, profiled for histone modification patterns, DNA accessibility, DNA methylation and RNA expression. We establish global maps of regulatory elements, define regulatory modules of coordinated activity, and their likely activators and repressors. We show that disease- and trait-associated genetic variants are enriched in tissue-specific epigenomic marks, revealing biologically relevant cell types for diverse human traits, and providing a resource for interpreting the molecular basis of human disease. Our results demonstrate the central role of epigenomic information for understanding gene regulation, cellular differentiation and human disease.

Integrative analysis of 111 reference human epigenomes

Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

Mo1335 Probe Based Confocal Laser Endomicroscopy (pCLE) in the Bile Duct for Indeterminate Stenosis: Be Careful With the Biliary Stenting!!!

Biliary tract injuries during cholecystectomy are a rare, but not exceptional, adverse event, with severe consequences. The Strasberg classification with Bismuth modification is most frequently used to classify biliary tract injuries [1, 2]. Expertise in endoscopic, radiologic, and surgical management is required, especially for major biliary tract injuries [3]. A transhepatic-endoscopic approach is useful in difficult cases [4, 5]. We aim to describe a new solution after failure of the standard rendezvous technique, namely double cholangioscopy rendezvous. A 21-year-old woman developed jaundice 3 months after she underwent cholecystectomy for lithiasis. The patient was referred to our center after undergoing an initial endoscopic retrograde cholangiopancreatography (ERCP), which was unsuccessful because of a blockage below the hilum (Strasberg–Bismuth E2) (▶Fig. 1). A repeat ERCP attempt also resulted in failure, and external percutaneous drainage was required, with an 8.5-Fr drain placed. The patient’s jaundice subsequently decreased. A joint decision was made by the gastroenterologists and surgeons to perform the rendezvous technique to avoid a hepaticojejunostomy with a high risk of secondary stricture because of its proximity to the convergence. The first attempt made at this procedure was unsuccessful, and the 8.5-Fr percutaneous drain was replaced with a 12-Fr drain (▶Fig. 2 a). A second attempt using simultaneous percutaneous cholangioscopy and ERCP was scheduled for a few days later (▶Video 1), but this repeat classical rendezvous technique was a failE-Videos

/pdf/a-novel-case-of-biliary-common-bile-duct-reconstruction-by-2gjnm97w.pdf

A novel case of biliary common bile duct reconstruction by the rendezvous technique using endoscopic cholangioscopy and percutaneous cholangioscopy

Digestive endoscopy, including endoscopic ultrasound, plays actually an important role in oncology concerning early diagnosis, tumor staging, and therapeutic procedures. Indeed, improvement of endoscope and dedicated accessories allow to increase applications of therapeutic endoscopy in oncologic indications : curative resection of early carcinoma ant submucosa tumor ; palliative treatment of tumoral bilio-digestive obstruction. Possibilities to resect sessile or flat polyps allow to treat curatively well-differentiated carcinoma without infiltration of the muscularis mucosae, the risk of lymph nodes invasion being null in this cases. In case of invasion of muscularis mucosae, this risk is inferior to 1% for colorectal cancer when submucosal invasion do not exceed 1000 microm but this risk is between 6 and 22% in case of oeso-gastric carcinoma invading the third part of the submucosa. Mortality of endoscopic resection was null in almost published series. Morbidity was 15-20% for colorectal resection with 5-6% of severe complications and up to 23% after oesophageal tumor ablation. Moreover, improvement of echoendoscope dedicated to therapeutic procedures allow from now to achieve non-anatomic pancreatic or biliary drainage through the gastric wall when the retrograde route is not suitable (whipple resection, duodenal stricture) or when drainage of the left hepatic lobe is difficult via the retrograde approach. The aim of this technique is to realize an anastomosis between the left hepatic duct and the stomach. Permanence of this fistula is ensured by insertion of one or two stent. Efficacy and safety of this procedure were recently retrospectively evaluated with a technical success in 91% of cases. Therapeutic endoscopy made many progress during the last years and development of new generation of endoscope and accessories would allow a real endoluminal surgical approach for superficial tumor, bilio-digestive anastomosis or gastro-enteroanastomosis by example.

Marc Giovannini

Papers

Mo1335 Probe Based Confocal Laser Endomicroscopy (pCLE) in the Bile Duct for Indeterminate Stenosis: Be Careful With the Biliary Stenting!!!

A novel case of biliary common bile duct reconstruction by the rendezvous technique using endoscopic cholangioscopy and percutaneous cholangioscopy

Frontiers in interventional endoscopy

Gastrin levels and colorectal cancer.

V.1.1: in-vivo miniprobe-based confocal fluorescence endomicroscopy (cellvizio) for hilar biliary strictures: an experience of two centres