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

The hepatic venous pressure gradient obtained by interventional radiology is the current gold-standard, indirect method for quantifying the degree of portal hypertension [1]. Direct measurement of the portal pressure gradient (PPG) under endoscopic ultrasound (EUS) guidance using 25-gauge [2, 3] and 22-gauge needles has been reported [4]. We here report on EUS-guided PPG in 21 patients, with successful assessment in 19 (90%) of these patients, using a dedicated 25-gauge needle (EchoTip Insight; Cook, Limerick, Ireland). Mean procedure time was 24±12 minutes. In 4 patients anticoagulants were withdrawn before the procedure. One patient had transient epigastric pain 3 days after the procedure, which had been combined with bilobar liver biopsy; hospital admission was not required. No other adverse events were registered either immediately or 1 month later. Technical difficulties encountered are demonstrated in ▶Video 1. In 2 cases (10%), EUS-guided measurement of PPG failed because of exacerbated breathing movements and to unreliability of the pressure measurements, probably due to excessive bending of the echoendoscope and needle (▶Fig. 1) and to use of the elevator and the up-and-down wheel. Thinner 25-gauge needles offer more flexibility and penetration ability than 22-gauge needles [5]. Occasionally, when puncturing the portal vein, even with a dedicated 25-gauge needle, the liver parenchyma is pushed away and the ultrasonographic window is momentarily lost. In such a case, the needle could puncture the hepatic artery. In 1 patient the 25-gauge needle passed close to the hepatic artery (▶Fig. 2). We experienced difficulty in puncturing the wall of the hepatic vein in 1 case and the portal vein in 2 cases, having to traverse these vessels (▶Fig. 3, ▶Fig. 4) and retrieve the needle. ▶Table1 shows the theoretical advantages of 25-gauge needles over 22-gauge needles in EUS-guided PPG measurement. To obtain reliable readings, forcing the elevator and the up-and-down wheel of the echoendoscope should be avoided. In reporting our experience here, our aim is to help make the procedure of EUSguided PPG measurement as safe and accurate as possible. Endoscopy_UCTN_Code_TTT_1AS_2AG Video 1 EUS-guided PPG measurement: safety and technical aspects.

Endoscopic ultrasound-guided portal pressure gradient measurement: improving safety and overcoming technical difficulties

Reply to R. Glynne-Jones et al.

http://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-2131-7180.pdf

Global prospective case series of ERCP using a single-use duodenoscope.

Radiofrequency ablation (RFA) has been used for the treatment of nonfunctional pancreatic neuroendocrine tumors (PNETs) < 2 cm [1], functional PNETs (insulinoma) [2], pancreatic metastasis of kidney cancer [3], and isolated cases of intraductal papillary mucinous neoplasm (IPMN) with worrisome features [4]. We describe the use of RFA to treat a compressive cervical lymph node causing dysphagia (▶Video 1). A 64-year-old woman undergoing palliative care for metastatic cervical cancer was treated with several lines of chemotherapy (cisplatin-paclitaxel, capecitabine, vinorelbine, paclitaxel, carboplatin, topotecan). The patient presented rapidonset, dysphagia progressing to grade IV due to a large cervical area lymph node metastasis. The patient had already undergone radiotherapy on the cervical area during the management of her disease. The stenosis was also too close to Killian’s triangle to place an esophageal stent. After discussion with the patient and because she could not swallow her own saliva without discomfort, we proposed the use of endoscopic ultrasoundguided RFA on the cervical area lymph nodes. RFA was performed with a therapeutic linear echoendoscope under carbon dioxide insufflation using EUS-RFA (Starmed/ TaeWoong Medical, Gimpo, South Korea). The procedure was performed with the patient sedated and intubated. Radiofrequency power was typically applied (50W) until the appearance of hyperechoic bubbles. The patient underwent one session of RFA, with two total RFA shots administered. Clinicians should be careful to not perform RFA too close to the esophageal wall to avoid potential fistula. The goal of the treatment was necrosis of the posterior part of the lymph node. After 2 days, the dysphasia was reduced to grade I. After 4 months, the patient received only supportive care owing to disease progression. RFA is a promising minimally invasive technique mainly described for PNETs, but additional applications are expected.

/pdf/radiofrequency-ablation-of-malignant-cervical-lymph-nodes-an-ddrwnv68.pdf

Marc Giovannini

Papers

Endoscopic ultrasound-guided portal pressure gradient measurement: improving safety and overcoming technical difficulties

Reply to R. Glynne-Jones et al.

Global prospective case series of ERCP using a single-use duodenoscope.

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

Contrast-Enhanced Endoscopic Ultrasound