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Sample records for submucosal tumor smt

  1. Diagnostic potential of endoscopic ultrasonography-elastography for gastric submucosal tumors: A pilot study.

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    Tsuji, Yuichiro; Kusano, Chika; Gotoda, Takuji; Itokawa, Fumihide; Fukuzawa, Masakatsu; Sofuni, Atsushi; Matsubayashi, Jun; Nagao, Toshitaka; Itoi, Takao; Moriyasu, Fuminori

    2016-03-01

    Qualitative diagnosis for gastric submucosal tumors (SMT) is not easy. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in combination with EUS-elastography (EUS-EG) is reported useful for qualitatively diagnosing pancreatic tissues. We prospectively studied whether EUS-EG could be useful in qualitative diagnosis of gastric SMT. We prospectively registered 25 consecutive patients with gastric SMT diagnosed by esophagogastroduodenoscopy and carried out qualitative evaluations using EUS-EG (May 2013 to March 2015) followed by histopathological diagnosis using EUS-FNA or endoscopic mucosal cutting biopsy. Elastic scores of gastric SMT were compared to the cytological diagnosis. Of 25 patients, 22 had a confirmed cytological diagnosis. Regarding the Giovannini elastic score, of three patients with aberrant pancreas, one was score 1 and two were score 2; of eight patients with leiomyoma, seven were score 2 and one was score 3. Both of two patients with schwannoma were score 4. Of nine patients with gastrointestinal stromal tumor, six were score 4 and three were score 5. Gastrointestinal stromal tumor (GIST) is harder than other types of gastric SMT, and our study's findings suggested the usefulness of EUS-EG, which can also assess tumor hardness of gastric SMT. EUS-EG might be helpful for the differential diagnosis of gastric SMT, especially to differentiate GIST from other SMT. © 2015 Japan Gastroenterological Endoscopy Society.

  2. Laparo-endoscopic transgastric resection of gastric submucosal tumors.

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    Barajas-Gamboa, Juan S; Acosta, Geylor; Savides, Thomas J; Sicklick, Jason K; Fehmi, Syed M Abbas; Coker, Alisa M; Green, Shannon; Broderick, Ryan; Nino, Diego F; Harnsberger, Cristina R; Berducci, Martin A; Sandler, Bryan J; Talamini, Mark A; Jacobsen, Garth R; Horgan, Santiago

    2015-08-01

    Laparoscopic and endoluminal surgical techniques have evolved and allowed improvements in the methods for treating benign and malignant gastrointestinal diseases. To date, only case reports have been reported on the application of a laparo-endoscopic approach for resecting gastric submucosal tumors (SMT). In this study, we aimed to evaluate the efficacy, safety, and oncologic outcomes of a laparo-endoscopic transgastric approach to resect tumors that would traditionally require either a laparoscopic or open surgical approach. Herein, we present the largest single institution series utilizing this technique for the resection of gastric SMT in North America. We performed a retrospective review of a prospectively collected patient database. Patients who presented for evaluation of gastric SMT were offered this surgical procedure and informed consents were obtained for participation in the study. Fourteen patients were included in this study between August/2010 and January/2013. Eight (8) patients (57.1 %) were female and the median age was 56 years (range 29-78). Of the 14 cases, 8 patients (57.1 %) underwent laparo-endoscopic resection of SMTs with transgastric extraction, 5 patients (35.7 %) had conversions to traditional laparoscopic surgery, and 1 patient (7.2 %) was abandoned intraoperatively. The median operative time for this cohort was 80 min (range 35-167). Ten patients (71.4 %) had GISTs, 3 (21.4 %) had leiomyomas, and 1 (7.1 %) had schwannoma. There were no intraoperative complications. Two patients had postoperative staple line bleeding that required repeat endoscopy. The median hospital stay was 1 day (range 1-6) and there were no postoperative mortalities. At 12-month follow-up visit, only one GIST patient (10 %) had tumor recurrence. Our experience suggests that this surgical approach is safe and efficient in the resection of gastric SMT with transgastric extraction. This study found no intraoperative complications and optimal oncologic outcomes during

  3. Single-incision laparoscopic partial gastrectomy for gastric submucosal tumors without compromising transumbilical stapling.

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    Takata, Akihiro; Nakajima, Kiyokazu; Kurokawa, Yukinori; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

    2014-01-01

    Although SILS has become an increasingly popular type of surgery, its application for gastric submucosal tumors (SMT) has been only sporadically reported. We herein describe 12 recent cases with gastric SMT located in the greater curvature or anterior wall. The aim is to validate technical feasibility and safety of single-incision laparoscopic partial gastrectomy. Thus far, this is one of the largest series of patients with gastric SMT who underwent SILS. From July 2009 to April 2013, single-incision laparoscopic partial gastrectomy was attempted in 12 consecutive patients with gastric SMT. Three trocars were assembled in the umbilical incision, and the lesion was mobilized and staple-resected with endoscopic stapling devices. SILS surgery was successfully completed without any additional trocars. The median operating time was 96.5 min, and median blood loss was 7.5 mL. The median tumor size was 30 mm, with histopathologic diagnosis of gastrointestinal stromal tumor (10) and schwannoma (2). There was no immediate postoperative morbidity. During a median follow-up of 12 months, all patients were on full regular diet without any gastrointestinal symptoms. SILS with transumbilical gastric stapling is a safe and practical alternative to conventional multiport laparoscopy in patients with gastric SMT, except for cases originating in the lesser curvature and close to the cardia/ pylorus. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  4. Deciding laparoscopic approaches for wedge resection in gastric submucosal tumors: a suggestive flow chart using three major determinants.

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    Lee, Chung-Ho; Hyun, Myung-Han; Kwon, Ye-Ji; Cho, Sung-Il; Park, Sung-Soo

    2012-12-01

    The aim of this study was to determine the optimal laparoscopic approach for wedge resection of gastric submucosal tumors (SMTs) based on tumor characteristics. Between March 2008 and June 2010, 57 patients underwent laparoscopic wedge resection for suspected gastric SMT. Of these 57 patients, 40 underwent exogastric wedge resection (EWR), with the remaining undergoing transgastric wedge resection (TWR). Fifty-seven consecutive patients undergoing surgical resection of gastric SMT were reviewed, with 40 and 17 tumors treated with EWR and TWR, respectively. The average tumor size was significantly greater in the EWR group (p = 0.004). A circular tumor location was a decisive factor for selecting the laparoscopic approach (p = 0.011). Tumors presenting with exophytic growths were predominantly found in the EWR group, and those with endophytic growth were dominant in the TWR group (p EWR or TWR revealed that tumor size (95% CI, 1.1 to 20.0; p = 0.033) and circular location of tumor (95% CI, 1.4 to 106.9; p = 0.021) were statistically significant factors. These data suggest a strategy for selection of appropriate laparoscopic wedge resection strategies based on tumor characteristics. This decision is affected by tumor size, location, and growth pattern. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Ameboma Mimicking Submucosal Tumor of the Colon in an Elderly

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    Shen-Yung Wang

    2011-06-01

    Full Text Available Ameboma is a rare presentation of intestinal amebiasis, which is caused by infection with Entamoeba histolytica. Amebomas are generally concentric and can be difficult to differentiate from carcinoma in the gastrointestinal tract, which are commonly seen in elderly patients. Radiological studies or colonoscopy can be difficult to provide the diagnosis. We present an elderly man with an ameboma in the ascending colon, which manifested as a submucosal tumor in the radiological or endoscopic studies. His serum antiamebic serology test was positive. He received surgery because of poor response to medical treatment. A full course of antiamebic therapy followed by a luminal agent were given and he had a smooth postoperative course without relapse of amebic infection. Although the elderly population has a higher incidence of colonic malignancy, ameboma should be considered in the differential diagnosis of submucosal tumors in the colon, especially in patients with an insidious onset of disease.

  6. Histological diagnosis of gastric submucosal tumors: A pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy.

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    Ikehara, Hisatomo; Li, Zhaoliang; Watari, Jiro; Taki, Masato; Ogawa, Tomohiro; Yamasaki, Takahisa; Kondo, Takashi; Toyoshima, Fumihiko; Kono, Tomoaki; Tozawa, Katsuyuki; Ohda, Yoshio; Tomita, Toshihiko; Oshima, Tadayuki; Fukui, Hirokazu; Matsuda, Ikuo; Hirota, Seiichi; Miwa, Hiroto

    2015-10-10

    To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) without cytology and mucosal cutting biopsy (MCB) in the histological diagnosis of gastric submucosal tumor (SMT). We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥ 1 cm in diameter. who underwent both EUS-FNAB and MCB were investigated. The histological diagnoses were gastrointestinal stromal tumors (n = 7), leiomyoma (n = 6), schwannoma (n = 2), aberrant pancreas (n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors' mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method (P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUS-FNAB (P = 0.03). No complications were found in either method. MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUS-FNAB should be performed for SMTs with extraluminal growth.

  7. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria.

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    Zhou, Ping-Hong; Yao, Li-Qing; Qin, Xin-Yu; Cai, Ming-Yan; Xu, Mei-Dong; Zhong, Yun-Shi; Chen, Wei-Feng; Zhang, Yi-Qun; Qin, Wen-Zheng; Hu, Jian-Wei; Liu, Jing-Zheng

    2011-09-01

    This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria. Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips. EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60-145) min. The mean resected lesion size was 2.8 (range, 1.2-4.5) cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8 months; range, 6-24 months). EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.

  8. Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors.

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    Hu, Bao-Guang; Wu, Feng-Jie; Zhu, Jun; Li, Xiao-Mei; Li, Yu-Ming; Feng, Yan; Li, He-Sheng

    2017-01-01

    Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Due to its rarity, GS is not widely recognized by clinicians, and the precise differential diagnosis between GS and other gastric submucosal tumors remains difficult preoperatively. The present study reports a case of GS misdiagnosed as gastrointestinal stromal tumor and reviews the clinical, imaging, and pathological features, treatment, and follow-up of 221 patients with GS previously reported in the English literature. Although GS is rare, the case reported in the current study highlights the importance of including GS in differential diagnoses of gastric submucosal tumors. Furthermore, the findings of the review suggest that although many cases are asymptomatic, the most common symptoms are abdominal pain or discomfort, not gastrointestinal bleeding, and malignant GSs present with clinical symptoms more commonly. Although large-sample multicenter studies on the efficacy, safety, and oncological outcomes of minimally invasive techniques are required, the findings presented herein may be helpful for clinicians when diagnosing or treating GS.

  9. Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors

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    Bao-guang Hu

    2017-01-01

    Full Text Available Gastric schwannoma (GS is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Due to its rarity, GS is not widely recognized by clinicians, and the precise differential diagnosis between GS and other gastric submucosal tumors remains difficult preoperatively. The present study reports a case of GS misdiagnosed as gastrointestinal stromal tumor and reviews the clinical, imaging, and pathological features, treatment, and follow-up of 221 patients with GS previously reported in the English literature. Although GS is rare, the case reported in the current study highlights the importance of including GS in differential diagnoses of gastric submucosal tumors. Furthermore, the findings of the review suggest that although many cases are asymptomatic, the most common symptoms are abdominal pain or discomfort, not gastrointestinal bleeding, and malignant GSs present with clinical symptoms more commonly. Although large-sample multicenter studies on the efficacy, safety, and oncological outcomes of minimally invasive techniques are required, the findings presented herein may be helpful for clinicians when diagnosing or treating GS.

  10. A case of pedunculated hepatic hemangioma mimicking submucosal tumor of the stomach.

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    Moon, Han Kook; Kim, Hyoung Su; Heo, Gyeong Mi; Shin, Woon Geon; Kim, Kyung Ho; Jang, Myoung Kuk; Lee, Jin Heon; Kim, Hak Yang; Kim, Doo Jin; Cho, Seong Jin

    2011-03-01

    Hepatic hemangioma is the most common benign tumor of the liver. Most such hemangiomas are small, asymptomatic, and have an excellent prognosis. Giant hepatic hemangioma has been reported in the literature, but the exophytic and pedunculated forms of hepatic hemangioma are rare. A 56-year-old woman was referred to our hospital under the suspicion of having a gastric submucosal tumor. Abdominal computer tomography (CT) scans showed a pedunculated mass from the left lateral segment of the liver into the gastric fundus, exhibiting the atypical CT findings of hepatic hemangioma. We therefore decided to perform laparoscopic resection based on the symptoms, relatively large diameter, inability to exclude malignancy, and risk of rupture of the exophytic lesion. The pathology indicated it to be a cavernous hemangioma of the liver. Herein we report a case of pedunculated hepatic hemangioma mimicking a submucosal tumor of the stomach due to extrinsic compression of the gastric fundus.

  11. Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection.

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    Xu, Mei-Dong; Wang, Xiao-Yun; Li, Quan-Lin; Zhou, Ping-Hong; Zhang, Yi-Qun; Zhong, Yun-Shi; Chen, Wei-Feng; Ma, Li-Li; Qin, Wen-Zheng; Hu, Jian-Wei; Yao, Li-Qing

    2013-01-01

    This study aims to investigate the clinicopathological features of specific subtypes of laterally spreading tumor (LST) and assessed the outcome of endoscopic submucosal dissection (ESD) based upon subdifferentiation status. A total of 137 LSTs were present in 135 patients; 96 were granular and 41 exhibited a nongranular pattern. Granular LSTs, subdivided into homogeneous and nodular mixed, and nongranular LSTs, subdivided into flat-elevated and pseudodepressed, were retrospectively evaluated with respect to clinicopathological features and results of ESD (en bloc R0 curative resection, procedure time, complication, and recurrence rate) according to specific subtype. The distribution of high-grade intraepithelial neoplasia and submucosal carcinomas was more prominent among granular nodular mixed tumors than among granular homogeneous tumors (P = 0.007), whereas there was no significant difference between nongranular pseudodepressed tumors and flat-elevated tumors. The frequency of en bloc R0 curative resection did not differ significantly among specific subtypes. For nodular mixed and pseudodepressed lesions, the median tumor size was significantly larger (P < 0.001 for each) and mean procedure time was also longer (P < 0.05 for each) than for the other two subtypes. All complications, which included three perforations, five episodes of postoperative bleeding, and one recurrence, occurred in granular nodular mixed and nongranular pseudodepressed tumors. The risk of cancer varies with the subtypes of LSTs. ESD is an effective treatment for LSTs, however ESD is more technically demanding and carries more complications in pseudodepressed and granular mixed subtypes.

  12. Submucosal tumor-like lesion originating from colon tuberculosis: a case report and review of the literature.

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    Shibagaki, Keiichi; Miyaike, Jirou; Onji, Morikazu; Tange, Kazuhiro; Bandou, Kenji; Takeji, Satoru; Murakami, Takatoshi; Ogawa, Taiji; Yamaguchi, Tomotaka; Uehara, Takahide; Hasebe, Aki; Kawasaki, Keitarou; Oomoto, Masaki

    2015-08-01

    A 76-year-old male had a solitary submucosal tumor-like lesion in the sigmoid colon originating from tuberculosis. The lesion, up to 1 cm in diameter, was found incidentally during a routine colonoscopy, which revealed a protuberant submucosal growth with a shallow depression of the overlying mucosa in the center of the tumor. Histologically, the endoscopic biopsy revealed caseating granulomas and infiltration of Langhans giant cells and epithelioid cells, consistent with tuberculosis, were also observed. Five reports of similar lesions from colon tuberculosis were found in a literature review, including the present case. In all cases, the submucosal tumor-like lesions which originated from tuberculosis were small and in an active stage of tuberculosis. Five cases of submucosal tumor-like lesions from gastric tuberculosis were also reported, with characteristics very similar to those of the lesions from colon tuberculosis. Therefore, we propose that lesions originating from tuberculosis should be included in the differential diagnosis of submucosal tumor-like lesions in the colon and stomach.

  13. Characteristics of Metachronous Gastric Tumors after Endoscopic Submucosal Dissection for Gastric Intraepithelial Neoplasms

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    Tomoyuki Boda

    2014-01-01

    Full Text Available Background. Recently, endoscopic submucosal dissection (ESD has become a standard treatment method for early gastric cancer and concurrent stomach preservation. However, metachronous recurrences have become a major problem. We evaluated the incidence and clinicopathologic features of and examined the risk factors for metachronous gastric tumors. Methods. A total of 357 patients who underwent ESD for gastric tumors (245 early gastric cancers and 112 adenomas and were followed up for more than 12 months without recurrence within the first 12 months were enrolled. We investigated the incidence and clinicopathologic features of metachronous tumors after ESD. We also analyzed the potential risk factors for metachronous tumors using the Kaplan-Meier method and Cox’s proportional hazards model. Results. The annual incidence of metachronous tumors after ESD was 2.4%. The median period until discovery after initial ESD was 26.0 months, and the median observation period was 52.6 months. Male patients developed metachronous tumors more frequently (P=0.04, and the hazard ratio of female to male patients was 0.36 (95% confidence interval: 0.11–0.89. Conclusions. Patients with a previous history of gastric tumors have a high risk of subsequent gastric tumor development and male patients should be carefully followed up after ESD for gastric tumor.

  14. Prognostic and diagnostic significance of tumor budding associated with β-catenin expression in submucosal invasive colorectal carcinoma.

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    Umemura, Ken; Takagi, Sho; Shimada, Takenobu; Masuda, Takayuki; Shiga, Hisashi; Takahashi, Shuichiro; Takahashi, Seiichi; Kinouchi, Yoshitaka; Shibuya, Daisuke; Shimosegawa, Tooru

    2013-01-01

    Endoscopic resection has become a major curative treatment for early colorectal carcinoma without lymph node metastasis. However, lymph node metastasis, a poor prognostic factor in colorectal carcinoma, occurs in about 10% of the patients with submucosal invasive colorectal carcinoma. Therefore, it is important to identify a high-risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma. This study was designed to identify the relationship between tumor budding with β-catenin expression and lymph node metastasis in submucosal invasive colorectal carcinoma. We investigated the immunohistochemistry of tumor budding in the 142 patients who underwent surgical resection for submucosal invasive colorectal carcinomas between 1984 and 1999 and the expression pattern of β-catenin in budding tumor cells. Accordingly, all the patients were followed up for at least 10 years or until death. Among the 142 patients, lymph node metastasis was detected in 14 patients (9.9%). Univariate analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was significantly associated with lymph node metastasis (P = 0.005). In contrast, tumor budding detected by hematoxylin and eosin staining was not associated with lymph node metastasis. Multivariate logistic regression analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was a significant risk factor for lymph node metastasis (odds ratio, 7.124; 95% confidence interval, 1.407-36.062). Thus, tumor budding associated with β-catenin expression is a risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma.

  15. Inflammatory Myofibroblastic Tumor: A Rarely Seen Submucosal Lesion of the Stomach

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    Deniz Arslan

    2013-01-01

    Full Text Available Inflammatory myofibroblastic tumor (IMT is a rare mesenchymal benign tumor which is generally seen in children and in young adults. It is especially located in the lungs. In histopathological examination, neoplastic fusiform cells originating from a subtype of accessory immune system cells which are called fibroblastic reticulum cells are seen (Kouichi and Youichirou, 2008. Although IMT is histopathologically benign, imaging methods show its tendency for local recurrence and invasion. In most of the cases, it may not be possible to make a distinction whether it is malign or benign. Complete surgical resection is the most important treatment method. In this study, we have discussed the findings of our case having a gastric submucosal located IMT in light of the current literatures.

  16. Endolumenal endoscopic full-thickness resection of muscularis propria-originating gastric submucosal tumors.

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    Feng, Yadong; Yu, Lianzhen; Yang, Shuping; Li, Xueliang; Ding, Jing; Chen, Li; Xu, Yinghong; Shi, Ruihua

    2014-03-01

    This study retrospectively reviewed 48 cases of gastric submucosal tumors (SMTs) treated by endolumenal endoscopic full-thickness resection (EFR) microsurgery in our gastrointestinal endoscopy center. From November 2009 to October 2012, 48 cases underwent endolumenal EFR for resection of muscularis propria-originating gastric SMTs. Characteristics of the 48 patients, clinical efficacy, safety of EFR, and post-EFR pathological diagnoses were evaluated retrospectively. EFR was successfully performed in 48 cases with 52 lesions. The median operation time was 59.72 minutes (range, 30-270 minutes; standard deviation, 39.72 minutes). The mean tumor size was 1.59 cm (range, 0.50-4.80 cm; standard deviation, 1.01 cm). During the EFR process, dual-channel gastroscopy was applied in 20 cases of SMTs, and paracentesis during the EFR process was applied in 9 cases. EFR for larger SMTs and gastric corpus-originating SMTs had longer operative times. Pathological diagnosis included 43 gastrointestinal stromal tumors, 4 leiomyomas, and 1 schwannoma. A larger tumor size was associated with higher risk of malignancy. No severe postoperative complications were observed. No tumor recurrences were confirmed in follow-up gastroscopy. The endolumenal EFR technique proved to be feasible and minimally invasive, even for the resection of large gastric tumors originating from the muscularis propria. However, more data on EFR must be obtained and analyzed.

  17. Preliminary analysis of hybrid laparoscopic procedure for resection of gastric submucosal tumors.

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    Caron, Pedro Henrique Lambach; Martins, Mariana Ismael Dias; Bertevello, Pedro Luiz

    2016-01-01

    to evaluate the feasibility, safety and benefits of minimally invasive surgery for resection of gastric submucosal tumor (GSMT). we conducted a retrospective study of medical records of patients undergoing endoscopy-assisted laparoscopic resection of gastric submucosal tumors (prospectively collected) from 2011 to 2014. We evaluated clinical data, surgical approach, clinicopathological characteristics of the GSMT (size, location, histopathological and immunohistochemical exams), outcome and patients follow-up. we evaluated six patients, 50% male, mean age 52±18 years and common symptoms of heartburn and gastric fullness. All patients underwent hybrid procedure without anatomical impairment of the organ. The average length of stay was 3.5 days and the average size of the tumors was 2.0±0.8cm, five of them (83%) in the proximal third of the stomach. The surgical specimens pathological and immunohistochemistry examination revealed one case of ectopic pancreas (17%), one grade 2 neuroendocrine tumor (17%), one lipoma (17%), one GIST (17%) and two leiomyomas (32%). There were no episodes of tumor rupture or intraoperative complications and no conversion to open surgery. During the postoperative follow-up period, none of the patients had recurrence, metastasis, fistula or stenosis. the results showed that endoscopy-assisted laparoscopic resection is feasible and safe for patients with GSMT. Endoscopy proved to be essential in the location of lesions and as intraoperative support, especially when attempting to preserve the pylorus and cardia during surgery. avaliar a viabilidade, segurança e vantagens da cirurgia minimamente invasiva para ressecção de tumores submucosos gástricos (TUSG). estudo retrospectivo dos prontuários de pacientes submetidos à ressecção videolaparoscópica assistida por endoscopia digestiva alta para tumores submucosos gástricos (coletados prospectivamente) de 2011 a 2014. Os fatores avaliados foram dados clínicos, abordagem cir

  18. Comparison between air and carbon dioxide insufflation in the endoscopic submucosal excavation of gastrointestinal stromal tumors.

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    Shi, Wei-Bin; Wang, Zi-Hao; Qu, Chun-Ying; Zhang, Yi; Jiang, Han; Zhou, Min; Chen, Ying; Xu, Lei-Ming

    2012-12-28

    To evaluate the safety and efficacy of CO(2) insufflation compared with air insufflation in the endoscopic submucosal excavation (ESE) of gastrointestinal stromal tumors. Sixty patients were randomized to undergo endoscopic submucosal excavation, with the CO(2) group (n = 30) and the air group (n = 30) undergoing CO(2) insufflation and air insufflation in the ESE, respectively. The end-tidal CO(2) level (pETCO(2)) was observed at 4 time points: at the beginning of ESE, at total removal of the tumors, at completed wound management, and 10 min after ESE. Additionally, the patients' experience of pain at 1, 3, 6 and 24 h after the examination was registered using a visual analog scale (VAS). Both the CO(2) group and air group were similar in mean age, sex, body mass index (all P > 0.05). There were no significant differences in PetCO(2) values before and after the procedure (P > 0.05). However, the pain scores after the ESE at different time points in the CO(2) group decreased significantly compared with the air group (1 h: 21.2 ± 3.4 vs 61.5 ± 1.7; 3 h: 8.5 ± 0.7 vs 42.9 ± 1.3; 6 h: 4.4 ± 1.6 vs 27.6 ± 1.2; 24 h: 2.3 ± 0.4 vs 21.4 ± 0.7, P < 0.05). Meanwhile, the percentage of VAS scores of 0 in the CO(2) group after 1, 3, 6 and 24 h was significantly higher than that in the air group (60.7 ± 1.4 vs 18.9 ± 1.5, 81.5 ± 2.3 vs 20.6 ± 1.2, 89.2 ± 0.7 vs 36.8 ± 0.9, 91.3 ± 0.8 vs 63.8 ± 1.3, respectively, P < 0.05). Moreover, the condition of the CO(2) group was better than that of the air group with respect to anal exsufflation. Insufflation of CO(2) in the ESE of gastrointestinal stromal tumors will not cause CO(2) retention and it may significantly reduce the level of pain, thus it is safe and effective.

  19. Efficacy of Endoscopic Submucosal Excavation for Gastrointestinal Stromal Tumors in the Cardia.

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    Wang, Shanshan; Shen, Lei

    2016-12-01

    Our goal was to estimate the feasibility and efficacy of endoscopic submucosal excavation (ESE) for the treatment of gastrointestinal stromal tumors (GISTs) in the cardia. We analyzed the clinical data of 30 patients who were diagnosed with GISTs after ESE in the cardia at the Endoscopy Center of Renmin Hospital of Wuhan University (China) from June 2009 to 2015. We evaluated the operative and postoperative conditions and long-term follow-up of these patients. The success rate and the complete resection rate were both 100%. The maximum diameter of the tumor ranged from 1.0 to 3.5 cm (2.2±0.2 cm). The operation time was 20 to 120 min (50±5 min). During ESE, bleeding occurred in all cases (100%) with a mean blood loss of 50 mL, and perforation in 6 (20%), including 2 full-thickness resections. GIST was confirmed by pathology in all cases. Follow-up included endoscopy at 1, 3, and 6 months, and at 1 year. At 1 month, ulcer was detected in 23 cases (76.67%), titanium clips remained in 17 cases (56.67%), and scar tissues were observed in the remainder. No recurrence was found with gastroscopy. The cardia is a unique anatomic location for GISTs, which often requires complex surgeries prone to complications. ESE for GISTs of the cardia is a challenging, but safe and effective procedure.

  20. Endoscopic Submucosal Dissection for Large Colorectal Tumor in a Japanese General Hospital

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    Ohata, Ken; Nonaka, Kouichi; Minato, Yohei; Misumi, Yoshitsugu; Tashima, Tomoaki; Shozushima, Meiko; Mitsui, Takahiro; Matsuhashi, Nobuyuki

    2013-01-01

    Background and Aims. Endoscopic submucosal dissection (ESD) is not widely used in large colorectal lesions because of technical difficulty and possible complications. We aimed to examine the efficacy and safety of ESD for large colorectal neoplasms. Patients and Methods. During the past 5 years, 608 cases of colorectal neoplasm (≧20 mm) were treated by ESD. They were divided into Group A (20–49 mm, 511 cases) and Group B (≧50 mm, 97 cases). Results. The average age, lesion size, and procedure time were 67.4 years, 30.0 mm, and 60.0 min in Group A, and they were 67.1 years, 64.2 mm, and 119.6 min in Group B. En bloc resection rates were 99.2% and 99.0% (P = 0.80), and complication rates were 4.1% and 9.9% (P = 0.03). Complications in Group A consisted of perforation (2.7%), bleeding (1.2%), and ischemic colitis (0.2%). Those in Group B were perforation (8.2%) and bleeding (1.0%). Two cases in Group A and none in Group B required emergency surgery for perforation. Conclusions. There was no difference in efficacy between Groups A and B. Complications were more frequent in Group B, but all perforations in Group B were successfully managed conservatively. ESD can be effective and safe for large colorectal tumors. PMID:24072998

  1. Stricture Occurring after Endoscopic Submucosal Dissection for Esophageal and Gastric Tumors

    Science.gov (United States)

    Kim, Gwang Ha; Jang, Jae Young; Shin, Sung Kwan; Choi, Kee Don; Lee, Jun Haeng; Kim, Sang Gyun; Sung, Jae Kyu; Choi, Suck Chei; Jeon, Seong Woo; Jang, Byung Ik; Huh, Kyu Chan; Chang, Dong Kyung; Jung, Sung-Ae; Keum, Bora; Cho, Jin Woong; Choi, Il Ju; Jung, Hwoon-Yong

    2014-01-01

    Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation. PMID:25505717

  2. Tumor budding as a risk factor of lymph node metastasis in submucosal invasive T1 colorectal carcinoma: a retrospective study

    Directory of Open Access Journals (Sweden)

    Kye Bong-Hyeon

    2012-08-01

    Full Text Available Abstract Background This study was designed to identify risk factors for lymph node metastasis of early stage colorectal cancer, which was confirmed to a carcinoma that invaded the submucosa after radical resection. Methods In total, 55 patients revealing submucosal invasive colorectal carcinoma on pathology who underwent curative radical resection at the Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea from January 2007 to September 2010 were evaluated retrospectively. Tumor size, depth of submucosal invasion, histologic grade, lymphovascular invasion, tumor budding, and microacinar structure were reviewed by a single pathologist. Student t-test for continuous variables and Chi-square test for categorical variables were used for comparing the clinicopathological features between two groups (whether lymph node involvement existed or not. Continuous variables are expressed as the mean ± standard error while statistical significance is accepted at P  Results The mean age of 55 patients (34 males and 21 females was 61.2 ± 9.6 years (range, 43–83. Histologically, eight (14.5% patients had metastatic lymph node. In the univariate analysis, tumor budding (P = 0.047 was the only factor that was significantly associated with lymph node metastasis. Also, the tumor budding had a sensitivity of 83.3%, a specificity of 60.5%, and a negative predictive value of 0.958 for lymph node metastasis in submucosal invasive T1 colorectal cancer. Conclusions The tumor budding seems to have a high sensitivity (83.3%, acceptable specificity (60.5%, and a high negative predictive value (0.958. A close examination of pathologic finding including tumor budding should be performed in order to manage early CRC properly.

  3. [Therapy of adult-onset laryngeal papilloma: integrallty submucosal dissection of the tumor by CO2 laser].

    Science.gov (United States)

    Lei, W B; Liu, Q H; Chai, L P; Zhu, X L; Wang, Z F; Li, Q M; Tang, H C; Jiang, A Y; Wen, Y H; Wen, W P

    2016-10-07

    Objective: To evaluate the feasibility and efficacy of the integrallty submucosal resection of adult-onset laryngeal papilloma by CO2 laser. Methods: A group of 64 cases (36 males and 28 females, multipe lesions 54 cases and single lesion 10 cases, aged 18-75 years, mean age 43.13 years) with adult-onset laryngeal papilloma encountered in the first affliated hospital of Sun Yatsen university from 2009 to 2015 was retrospectively analyzed. All cases were treated with integrallty submucosal dissection of the tumor by CO2 laser, and observed the changes of tumor integral scope, inter-operative, operative processes, postoperative voice quality, postoperative scarring, and the tracheotomy conditions, which were analysed and evaluated. Results: A total of 64 patients were followed up from 1 year to 5 years. Preoperative tumor integral scope of these patients averaged of 7.00. A total of 62 cases kept 0 score of the tumor integral scope for at least one year, which lead to a clinical cure rate of 96.9%. The inter-operative averaged of 25.7 months. The total operative processes of these patients were 87 times (mean time 1.36). Four cases resulted in postoperative scarring. However these was a good result in postoperative voice quality with a mean score 4.25. As to the changes of tumor integral scope, all cases got a declining score (mean score 6.72), which resulted in a remission rate of 100%. Conclusion: The integrallty submucosal dissection of adult-onset 1aryngeal papilloma by CO2 laser was an effective way to reduce the tumor integral scope; lengthen their inter-operative; decrease the operative processes, avoid the occurrence of tracheotomy; and improve the postoperative voice quality. Most of the patients could even be cured ultimately.

  4. Deep biopsy via endoscopic submucosal dissection in upper gastrointestinal subepithelial tumors: a prospective study.

    Science.gov (United States)

    Tae, Hye Jin; Lee, Hang Lak; Lee, Kang Nyeong; Jun, Dae Won; Lee, Oh Young; Han, Dong Soo; Yoon, Byung Chul; Choi, Ho Soon; Hahm, Joon Soo

    2014-10-01

    Preoperative pathological diagnosis may improve clinical management decisions in patients with upper gastrointestinal subepithelial tumors (SETs). The aims of this study were to evaluate the diagnostic yield of deep biopsy via an endoscopic submucosal dissection (ESD) technique, the complications associated with the procedure, and the impact on management of patients with upper gastrointestinal SETs. A total of 68 patients with SETs in the stomach or esophagus were voluntarily assigned to two groups. One group underwent endoscopic ultrasound (EUS) and endoscopic deep biopsy using the ESD technique (40 patients), and the other group (28 patients) underwent surgical resection after EUS without obtaining preoperative pathological diagnosis, in accordance with accepted clinical management algorithms. The diagnostic yield of deep biopsy was 90 % (36/40). The results of deep biopsy changed the treatment plans in 14/40 patients (35 %). One patient with lymphoepithelial carcinoma was scheduled for surgical resection, and 13 patients with benign SETs of diameter ≥  2 cm avoided surgery. Of the 28 patients who underwent surgical resection without preoperative pathological diagnosis, 12 (42.9 %) were confirmed to have benign lesions. The mean procedure time for deep biopsy was 13.7 minutes. There were no procedure-related complications in the deep biopsy group.  Deep biopsy by the ESD technique is a safe, high-yield, diagnostic method in patients with upper gastrointestinal SETs. Pathologic confirmation could improve clinical decision making in the management of patients with upper gastrointestinal SETs. NCT 01993199. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: is it feasible?

    Science.gov (United States)

    Jung, Da Hyun; Youn, Young Hoon; Kim, Jie-Hyun; Park, Hyojin

    2015-03-01

    Colorectal endoscopic submucosal dissection (ESD) was applied to lesions, such as giant colorectal lateral spreading tumors (LSTs) > 10 cm, by an expert ESD endoscopist despite several limitations, such as a relatively high perforation rate and high technical difficulty. To investigate the feasibility and safety of ESD for giant colorectal LSTs ≥ 10 cm. Retrospective study. Tertiary-care center. A total of 163 patients underwent colorectal ESD between 2009 and 2014 by a single expert ESD endoscopist at Gangnam Severance Hospital, Seoul, Korea. Among them, 9 patients had giant colorectal LSTs ≥ 10 cm. Review of records. Clinicopathologic factors and oncologic outcome associated with ESD between giant colorectal LSTs and others. Colorectal LSTs ≥ 10 cm were classified as giant colorectal LSTs. Nine giant colorectal LST lesions were localized to the following regions: descending colon (n = 1), sigmoid colon (n = 1), and rectum (n = 7). The average maximal diameter of giant colorectal LSTs was 120.8 mm, and the procedure time was 270.0 minutes. Two lesions were of the whole nodular type, and 7 were focal nodular lesions. The en bloc and curative resection rates for ESD for giant colorectal LSTs were 88.9% and 100%, respectively. The adverse event rate was 44.4%. No strictures, local recurrences, or distant metastases occurred over a mean follow-up period of 27.1 months. Retrospective, single-center study. ESD of giant colorectal LSTs appears to be a feasible and curative treatment, even though it is associated with a higher adverse event rate, higher degree of technical difficulty, and longer procedure time. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  6. Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT.

    Science.gov (United States)

    Choi, Jin Wook; Choi, Dongil; Kim, Kyoung-Mee; Sohn, Tae Sung; Lee, Jun Haeng; Kim, Hee Jung; Lee, Soon Jin

    2012-01-01

    To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.

  7. Small Submucosal Tumors of the Stomach: Differentiation of Gastric Schwannoma from Gastrointestinal Stromal Tumor with CT

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Wook; Choi, Dong Gil; Kim, Kyoung Mee; Sohn, Tae Sung; Lee, Jun Haeng; Kim, Hee Jung; Lee, Soon Jin [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2012-07-15

    To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.

  8. POEM and Submucosal Tunneling.

    Science.gov (United States)

    Werner, Yuki B; Rösch, Thomas

    2016-06-01

    Submucosal endoscopy has introduced new and important aspects into gastrointestinal endoscopic therapeutics by opening the way to interventions even outside of the GI tract. At present, innovative techniques for submucosal endoscopy in different esophageal diseases include peroral endoscopic myotomy (POEM) for idiopathic achalasia and related motility disorders, submucosal tunneling endoscopic resection (STER) for submucosal tumors arising from the muscularis propria, and endoscopic submucosal tunneling dissection (ESTD) for superficial esophageal neoplastic lesions. POEM for achalasia-still a rare disease-is currently evaluated in comparison to endoscopic and surgical standard therapies, while this procedure enabling a long thoracic myotomy might constitute an advantage over the laparoscopic approach in treatments of spastic esophageal diseases. Removal of smaller submucosal esophageal tumors may appear tempting, but the clinical indications are limited by the facts that the vast majority of such smaller tumors are asymptomatic and benign.For all these innovative and technically demanding techniques, learning curves have to be taken into account, not only with regard to technical competence but also to clinical assessment, ranging from proper indication and patient selection to the management of (potential) complications and logistics/back-up. Although preliminary results from high-skilled endoscopic centers have been very encouraging, long-term data as well as prospective randomized controlled trials are needed to validate the efficacy and safety of the modalities.

  9. Various features of laparoscopic tailored resection for gastric submucosal tumors: a single institution's results for 168 patients.

    Science.gov (United States)

    Choi, Chang In; Lee, Si Hak; Hwang, Sun Hwi; Kim, Dae Hwan; Jeon, Tae Yong; Kim, Dong Heon; Park, Do Youn

    2016-04-01

    Laparoscopic resection is a standard procedure for gastric submucosal tumors. Herein, we analyzed the features of various laparoscopic approaches. Between January 2007 and November 2013, 168 consecutive patients who underwent laparoscopic resection for gastric submucosal tumors were enrolled. Patients' demographics and clinicopathologic and perioperative data were reviewed retrospectively. Among the 168 patients, exogastric wedge resection was performed in 99 cases (58.9%), single-port intragastric resection was performed in 30 cases (17.9%), eversion technique was used in 17 cases (10.1%), transgastric resection was performed in 8 cases (4.8%), and single-port wedge resection was performed in 6 cases (3.6%). The remaining cases underwent single-port exogastric wedge resection, laparoscopic and endoscopic cooperative surgery, or major resection. Mean age was 56.8 ± 13.3 years, and body mass index was 24.0 ± 3.2 kg/m(2). Mean operation time was 96.1 ± 58.9 min; laparoscopic proximal gastrectomy had the longest operation time (3 cases, 291.7 ± 129.0 min). In contrast, the laparoscopic eversion technique had the shortest operation time (82.6 ± 32.8 min). Pathologic data revealed a mean tumor size of 2.9 ± 1.2 cm (with a range of 0.8-8.0 cm). Tumors were most common on the body (98 cases, 58.3%), followed by the fundus (44 cases, 26.2%). Exophytic growth occurred in 39 cases (23.2%), endophytic growth occurred in 89 cases (53.0%), and dumbbell-type growth occurred in 40 cases (23.8%). Gastrointestinal stromal tumors occurred in 130 cases (77.4%), and schwannomas occurred in 23 (13.7%). Thirteen patients had postoperative complications (delayed gastric emptying in 5, stricture in 3, bleeding in 3, others in 2). The mean follow-up period was 28.8 ± 20.8 months, and there were three recurrences (1.8%) at 6, 19 and 31 months after the initial surgery. For gastric submucosal tumors with appropriate locations and growth types, laparoscopic tailored resection which

  10. [Synchronous Double Cancer Involving Gastric Cancer Resembling a Submucosal Tumor with Stenosis in the Pylorus and Ascending Colon Cancer - A Case Report].

    Science.gov (United States)

    Miyauchi, Tatsuomi; Miyaki, Akira; Ida, Arika; Kishibe, Saki; Yamaguchi, Kentaro; Shiozawa, Shunichi; Usui, Takebumi; Kuhara, Kotaro; Kono, Teppei; Naritaka, Yoshihiko

    2016-11-01

    An 82-year-old woman presented to our hospital with a complaint of frequent vomiting. She was admitted for intensive examination and treatment. Abdominal computed tomography revealed that her stomach was severely expanded, and the wall of the ascending colon was thickened throughout its circumference. Upper gastrointestinal endoscopy uncovered severe stenosis in the pylorus and an elevated lesion resembling a submucosal tumor on the posterior wall of the pylorus. Biopsies of the lesion revealed that it was of Group 1. On colonoscopy, type 2 cancer was found in the ascending colon throughout the circumference, and the biopsies revealed that it was of Group 5. Upper gastrointestinal endoscopy was repeated, and the same result was obtained. The possibility of malignancy could not be excluded; therefore, distal gastrectomy and right colectomy were performed. In terms of histopathology, both resected specimens displayed poorly differentiated adenocarcinoma; however, immunohistochemical studies revealed differences in staining at the two sites. The case was diagnosed as synchronous double cancer involving gastric cancer resembling a submucosal tumor with stenosis in the pylorus and ascending colon cancer. Gastric cancer resembling a submucosal tumor is usually difficult to diagnose on biopsy. If the endoscopic findings reveal an elevated lesion resembling a submucosal tumor with stenosis, then the possibility of carcinoma should be considered, and the most suitable treatment should be selected.

  11. Small neuroendocrine tumor of the duodenal bulb: Endoscopic submucosal dissection, laparoscopic and endoscopic cooperative surgery or surgery?

    Directory of Open Access Journals (Sweden)

    Nikolaos V Chrysanthos

    2016-01-01

    Full Text Available Neuroendocrine neoplasms of the gastric tube are less common than adenocarcinomas. Topography includes stomach, small intestine, Vater ampulla, and gross intestine. They are graded as neuroendocrine tumors grade I and II (NETs GI and GII and neuroendocrine carcinomas GIII based on Ki-67 index and mitotic count. [1] Endoscopic treatment for GI NETs ≤1 cm that does not extend beyond the submucosal layer and does not demonstrate lymph node metastasis is recommended. Tumors ≥2 cm, with lymph node metastasis, are indicated for surgical treatment. The treatment strategy for tumors between 10 and 20 mm in size remains controversial. [2] We present a rare case of a 60-year-old male patient with end-stage renal failure who underwent a screening pretransplantation endoscopic control. Colonoscopy had no pathological findings. Gastroscopy reveals an abnormal mucosa in the anterior upper part of the duodenal bulb that was described as a micronodular mucosa and a central nodule of 6 mm with erythematous mucosa. Histology of the micronodular mucosa reveals a heterotopic gastric mucosa and a small hyperplastic polyp. Biopsies from the nodule reveal a carcinoid tumor (NET GI. Immunohistochemistry: Positive chromogranin levels, low mitotic index (1/10 HPF, and Ki-67 index 2 cm and those of the duodenal bulb with histological extensions and the lack of assessing depth invasion.

  12. Rewriting Modulo SMT

    Science.gov (United States)

    Rocha, Camilo; Meseguer, Jose; Munoz, Cesar A.

    2013-01-01

    Combining symbolic techniques such as: (i) SMT solving, (ii) rewriting modulo theories, and (iii) model checking can enable the analysis of infinite-state systems outside the scope of each such technique. This paper proposes rewriting modulo SMT as a new technique combining the powers of (i)-(iii) and ideally suited to model and analyze infinite-state open systems; that is, systems that interact with a non-deterministic environment. Such systems exhibit both internal non-determinism due to the system, and external non-determinism due to the environment. They are not amenable to finite-state model checking analysis because they typically are infinite-state. By being reducible to standard rewriting using reflective techniques, rewriting modulo SMT can both naturally model and analyze open systems without requiring any changes to rewriting-based reachability analysis techniques for closed systems. This is illustrated by the analysis of a real-time system beyond the scope of timed automata methods.

  13. Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

    Directory of Open Access Journals (Sweden)

    Palmieri Giovanni

    2010-11-01

    Full Text Available Abstract Background Endoscopic submucosal dissection (ESD is an advanced technique of therapeutic endoscopy alternative to endoscopic mucosal resection (EMR for superficial gastrointestinal neoplasms >2 cm. ESD allows for the direct dissection of the submucosa and large lesions can be resected en bloc. ESD is not limited by resection size, increases histologically complete resection rates and may reduce the local recurrence. Nevertheless, the technique is time-consuming, technically demanding and associated with a high complication rate. To reduce the risk of complications, different devices and technical advances have been proposed with conflicting results and, still, ESD en bloc resections of huge lesions are associated with increased complications. Case Presentation We successfully used a combined ESD/EMR technique for huge rectal laterally spreading tumors (LSTs. ESD was used for circumferential resection of 2/3 of the lesion followed by piecemeal resection (2-3 pieces of the central part of the tumour. In all three patients we obtained the complete dissection of the polyp and the complete histological evaluation in absence of complications and recurrence at 6 months' follow up. Conclusions In the treatment of rectal LSTs, the combined treatment - ESD/EMR resection may be considered a suitable therapeutic option, indicated in selected cases as an alternative to surgery, in which the two techniques are neither reliable nor safe separately. However, to confirm our results, larger trials with longer follow up are required together with improvement of the technique and of the technical devices.

  14. SMT-Aware Instantaneous Footprint Optimization

    Energy Technology Data Exchange (ETDEWEB)

    Roy, Probir; Liu, Xu; Song, Shuaiwen

    2016-05-31

    Modern architectures employ simultaneous multithreading (SMT) to increase thread-level parallelism. SMT threads share many functional units and the whole memory hierarchy of a physical core. Without a careful code design, SMT threads can easily contend with each other for these shared resources, causing severe performance degradation. Minimizing SMT thread contention for HPC applications running on dedicated platforms is very challenging, because they usually spawn threads within Single Program Multiple Data (SPMD) models. To address this important issue, we introduce a simple scheme for SMT-aware code optimization, which aims to reduce the memory contention across SMT threads.

  15. vZ - An Optimizing SMT Solver

    DEFF Research Database (Denmark)

    Bjørner, Nikolaj; Dung, Phan Anh; Fleckenstein, Lars

    2015-01-01

    Z provides a portfolio of approaches for solving linear optimization problems over SMT formulas, MaxSMT, and their combinations. Objective functions are combined as either Pareto fronts, lexicographically, or each objective is optimized independently. We describe usage scenarios of vZ, outline the tool......vZ is a part of the SMT solver Z3. It allows users to pose and solve optimization problems modulo theories. Many SMT applications use models to provide satisfying assignments, and a growing number of these build on top of Z3 to get optimal assignments with respect to objective functions. v...

  16. Predicting SMT Solver Performance for Software Verification

    Directory of Open Access Journals (Sweden)

    Andrew Healy

    2017-01-01

    Full Text Available The Why3 IDE and verification system facilitates the use of a wide range of Satisfiability Modulo Theories (SMT solvers through a driver-based architecture. We present Where4: a portfolio-based approach to discharge Why3 proof obligations. We use data analysis and machine learning techniques on static metrics derived from program source code. Our approach benefits software engineers by providing a single utility to delegate proof obligations to the solvers most likely to return a useful result. It does this in a time-efficient way using existing Why3 and solver installations - without requiring low-level knowledge about SMT solver operation from the user.

  17. Reliability Analysis of Surface Mount Technology (SMT)

    Science.gov (United States)

    1993-03-01

    380, 1981. 7. J. DeVore; "The Mechanisms of Solderability and Solderability Related Failures," General Electric, WCIII-43, Printed Circuit World Convention...34Thermal Cycles and Surface Mounting Attachment Reliability," Circuit World , Vol. Il, 1985 76. J. Collett; "SMT Solder Joint Reliability," IPC-TP-708

  18. Endoscopic submucosal dissection

    DEFF Research Database (Denmark)

    Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry

    2015-01-01

    UNLABELLED: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. MAIN...... RECOMMENDATIONS: 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when...... they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality...

  19. Ectopic Pancreas in the Stomach Successfully Resected by Endoscopic Submucosal Dissection

    Directory of Open Access Journals (Sweden)

    Masaya Iwamuro

    2015-01-01

    Full Text Available A 32-year-old Japanese man presented with a gastric submucosal tumor. Esophagogastroduodenoscopy showed a sessile submucosal tumor measuring approximately 10 mm in diameter on the greater curvature of the gastric antrum. Endoscopic ultrasonography examination revealed a solid tumor with a diameter of 11.8 mm, which was located in the deep mucosal and submucosal layers. The internal echogenicity was homogenous and hypoechoic. Biopsy examinations were performed twice but were not diagnostic since only the intact mucosal layer was obtained. The patient was subsequently diagnosed with ectopic pancreas in the stomach by endoscopic submucosal dissection (ESD. This case underscores the usefulness of the ESD technique for the pathological diagnosis of gastric submucosal tumors.

  20. Handbook of machine soldering SMT and TH

    CERN Document Server

    Woodgate, Ralph W

    1996-01-01

    A shop-floor guide to the machine soldering of electronics Sound electrical connections are the operational backbone of every piece of electronic equipment-and the key to success in electronics manufacturing. The Handbook of Machine Soldering is dedicated to excellence in the machine soldering of electrical connections. Self-contained, comprehensive, and down-to-earth, it cuts through jargon, peels away outdated notions, and presents all the information needed to select, install, and operate machine soldering equipment. This fully updated and revised volume covers all of the new technologies and processes that have emerged in recent years, most notably the use of surface mount technology (SMT). Supplemented with 200 illustrations, this thoroughly accessible text Describes reflow and wave soldering in detail, including reflow soldering of SMT boards and the use of nitrogen blankets * Explains the setup, operation, and maintenance of a variety of soldering machines * Discusses theory, selection, and control met...

  1. Small bud of probable gastrointestinal stromal tumor within a laparoscopically-resected gastric schwannoma.

    Science.gov (United States)

    Cho, Haruhiko; Watanabe, Takafumi; Aoyama, Toru; Hayashi, Tsutomu; Yamada, Takanobu; Ogata, Takashi; Yoshikawa, Takaki; Tsuburaya, Akira; Sekiguchi, Hironobu; Nakamura, Yoshiyasu; Sakuma, Yuji; Kameda, Yoichi; Miyagi, Yohei

    2012-06-01

    Submucosal tumors (SMTs) of the gastrointestinal (GI) tract can be potentially difficulty to diagnose pathologically. We report a case of a gastric SMT that was resected by laparoscopic partial gastrectomy. Although the initial histological and immunohistochemical examinations considered the tumor as a schwannoma, mRNA-based KIT genotyping indicated that the tumor included cells with KIT gene expression, and that a small number of cells carried a deletion mutation in exon 11. Additional histopathological investigations revealed small aggregates of enlarged spindle to epithelioid cells, which were positive for KIT, CD34 and DOG1, and negative for S-100, scattered among the S-100-positive schwannoma cells. We consider that the cells carrying the KIT gene mutation are microscopic buds of a gastrointestinal stroma tumor (GIST), and to the best of our knowledge, this is the first report of probable GIST tissues identified in a schwannoma. Our observations raised the significance of genotyping for diagnosis of GI tract SMTs.

  2. Transanal submucosal endoscopic resection (TASER) by TEO system®.

    Science.gov (United States)

    Muñoz de Nova, José Luis; Viamontes Ugalde, Francisco Eduardo; Mendoza Jiménez-Ridruejo, Jorge

    2016-07-01

    Given the higher incidence of non-invasive colorectal tumors due to the further implementation of screening techniques, multiple endoscopic techniques have emerged for its resection. Recently described, transanal submucosal endoscopic resection (TASER) pools the concepts of endoscopic resection with the transanal surgery. We report our initial experience and reflections on this new technique.

  3. Submucosal endoscopy: from ESD to POEM and beyond.

    Science.gov (United States)

    Inoue, Haruhiro; Santi, Esperanza Grace; Onimaru, Manabu; Kudo, Shin-ei

    2014-04-01

    Peroral endoscopic myotomy (POEM) is an evolving minimally invasive endoscopic surgical procedure, with no skin incision, intended for long-term recovery from symptoms of esophageal achalasia. POEM was developed based on both the already established surgical principles of esophageal myotomy and the advanced techniques of endoscopic submucosal dissection. This article relates how POEM was developed, and its use in practice is reported and discussed. As an extension of the POEM technique, submucosal endoscopic tumor resection is introduced. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

    OpenAIRE

    Yoon, William; Paulson, Kari; Mazzara, Paul; Nagori, Sweety; Barawi, Mohammed; Berri, Richard

    2012-01-01

    Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should i...

  5. Usefulness of endoscopic ultrasonography in the preoperative diagnosis of submucosal digestive tumours Utilidad de la encoendoscopia en el diagnóstico preoperatorio de malignidad de los tumores submucosos digestivos

    Directory of Open Access Journals (Sweden)

    D. Martínez-Ares

    2005-06-01

    Full Text Available Introduction: the preoperative diagnosis of submucosal lesions in the gut may be complicated. Conventional endoscopy does not allow to clearly establishing a diagnosis, and does not adequately assess lesion size. Furthermore, endoscopic biopsy is usually not diagnostic. Cytology as performed by means of fine-needle puncture does not have enough sensitivity and specificity to be considered the gold standard in the diagnosis of these lesions. We will now assess the usefulness of endoscopic ultrasonography in the study of submucosal digestive tumors. Materials and methods: we have prospectively collected ultrasonographic studies from all the patients with submucosal tumors who were treated surgically. We assessed the sensitivity and specificity of this technique in the diagnosis of malignancy in said lesions, alongside factors that predict malignant behavior with the highest reliability. We also valued the reliability of ultrasound endoscopy in the assessment of lesion size and the wall layer where lesions are located. The results of histological studies were considered the gold standard. Results: the average size of lesions as measured by ultrasound endoscopy was 37.42 mm, with no significant differences in surgical piece: 38.98 (p = 0.143. However, conventional endoscopy underestimates the size of lesions. Endoscopic ultrasonography was able to adequately establish the origin layer of lesions in all cases. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound endoscopy in the diagnosis of malignancy were 89.5, 90.9, 89.5, and 90.9%, respectively. In the univariate analysis, the ultrasonographic characteristics associated with a diagnosis of malignancy included presence of ulceration (p = 0.043, size above 4 cm (p = 0.049, irregular edges of lesion (p = 0.0001, a heterogeneous ultrasonographic pattern (p = 0.002, and the presence of cystic areas above 2 mm (p = 0.012. In the multivariate analysis, the

  6. The TALP & I2R SMT Systems for IWSLT 2008

    OpenAIRE

    Li, H.; Aw, A.; M. Zhang; Khalilov, Maxim; Ruiz Costa-Jussà, Marta; Henríquez Quintana, Carlos Alberto; Rodríguez Fonollosa, José Adrián; Hernández, A.; Mariño Acebal, José Bernardo; Banchs Martínez, Rafael Enrique; Chen, B

    2008-01-01

    This paper gives a description of the statistical machine translation (SMT) systems developed at the TALP Research Center of the UPC (Universitat Polit`ecnica de Catalunya) for our participation in the IWSLT’08 evaluation campaign. We present Ngram-based (TALPtuples) and phrase-based (TALPphrases) SMT systems. The paper explains the 2008 systems’ architecture and outlines translation schemes we have used, mainly focusing on the new techniques that are challenged to imp...

  7. Fatal submucosal invasive gastric adenosquamous carcinoma detected at surveillance after gastric endoscopic submucosal dissection

    Science.gov (United States)

    Shirahige, Akinori; Suzuki, Haruhisa; Oda, Ichiro; Sekiguchi, Masau; Mori, Genki; Abe, Seiichiro; Nonaka, Satoru; Yoshinaga, Shigetaka; Sekine, Shigeki; Kushima, Ryoji; Saito, Yutaka; Fukagawa, Takeo; Katai, Hitoshi

    2015-01-01

    An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Two years after the initial ESD, a 0-IIc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric antrum. The estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated adenocarcinoma. ESD was performed for this lesion and en bloc resection with negative margins was achieved. Histopathological examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer (1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative resection. Additional gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical resection. Systemic chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second ESD. Early gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well known. The present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer. PMID:25892891

  8. Smt3 is required for Drosophila melanogaster metamorphosis.

    Science.gov (United States)

    Talamillo, Ana; Sánchez, Jonatan; Cantera, Rafael; Pérez, Coralia; Martín, David; Caminero, Eva; Barrio, Rosa

    2008-05-01

    Sumoylation, the covalent attachment of the small ubiquitin-related modifier SUMO to target proteins, regulates different cellular processes, although its role in the control of development remains unclear. We studied the role of sumoylation during Drosophila development by using RNAi to reduce smt3 mRNA levels in specific tissues. smt3 knockdown in the prothoracic gland, which controls key developmental processes through the synthesis and release of ecdysteroids, caused a 4-fold prolongation of larval life and completely blocked the transition from larval to pupal stages. The reduced ecdysteroid titer of smt3 knockdown compared with wild-type larvae explains this phenotype. In fact, after dietary administration of exogenous 20-hydroxyecdysone, knockdown larvae formed pupal cases. The phenotype is not due to massive cell death or degeneration of the prothoracic glands at the time when puparium formation should occur. Knockdown cells show alterations in expression levels and/or the subcellular localisation of enzymes and transcription factors involved in the regulation of ecdysteroid synthesis. In addition, they present reduced intracellular channels and a reduced content of lipid droplets and cholesterol, which could explain the deficit in steroidogenesis. In summary, our study indicates that Smt3 is required for the ecdysteroid synthesis pathway at the time of puparium formation.

  9. Certified Satisfiability Modulo Theories (SMT) Solving for System Verification

    Science.gov (United States)

    2017-01-01

    instrumentation in the theory solvers as well as additional deduction rules and axioms beyond Boolean resolution. More generally, SMT proofs typically have a...module is built by the functor module. One can see the bit vector structure (a Coq record) by using the destruct tactic (in Coq ’s proof editing mode...Oliveras, and C. Tinelli, “Splitting On Demand in SAT Modulo Theories,” in Proc. 13th int. conf. on logic for programming, artificial intelligence

  10. Using computer algebra and SMT solvers in algebraic biology

    Science.gov (United States)

    Pineda Osorio, Mateo

    2014-05-01

    Biologic processes are represented as Boolean networks, in a discrete time. The dynamics within these networks are approached with the help of SMT Solvers and the use of computer algebra. Software such as Maple and Z3 was used in this case. The number of stationary states for each network was calculated. The network studied here corresponds to the immune system under the effects of drastic mood changes. Mood is considered as a Boolean variable that affects the entire dynamics of the immune system, changing the Boolean satisfiability and the number of stationary states of the immune network. Results obtained show Z3's great potential as a SMT Solver. Some of these results were verified in Maple, even though it showed not to be as suitable for the problem approach. The solving code was constructed using Z3-Python and Z3-SMT-LiB. Results obtained are important in biology systems and are expected to help in the design of immune therapies. As a future line of research, more complex Boolean network representations of the immune system as well as the whole psychological apparatus are suggested.

  11. From POEM to POET: Applications and perspectives for submucosal tunnel endoscopy.

    Science.gov (United States)

    Chiu, Philip W Y; Inoue, Haruhiro; Rösch, Thomas

    2016-12-01

    Recent advances in submucosal endoscopy have unlocked a new horizon for potential development in diagnostic and therapeutic endoscopy. Increasing evidence has demonstrated that peroral endoscopic myotomy (POEM) is not only clinically feasible and safe, but also has excellent results in symptomatic relief of achalasia. The success of submucosal endoscopy in performance of tumor resection has confirmed the potential of this new area in diagnostic and therapeutic endoscopy. This article reviews the current applications and evidence, from POEM to peroral endoscopic tunnel resection (POET), while exploring the possible future clinical applications in this field. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Endoscopically removed giant submucosal lipoma

    Directory of Open Access Journals (Sweden)

    Jovanović Ivan

    2007-01-01

    Full Text Available Background. Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. Case report. A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. Conclusion. Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.

  13. Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias

    Science.gov (United States)

    Muraki, Yosuke; Enomoto, Shotaro; Iguchi, Mikitaka; Niwa, Toru; Maekita, Takao; Yoshida, Takeichi; Moribata, Kosaku; Shingaki, Naoki; Deguchi, Hisanobu; Ueda, Kazuki; Inoue, Izumi; Tamai, Hideyuki; Kato, Jun; Fujishiro, Mitsuhiro; Ichinose, Masao

    2012-01-01

    AIM: To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric neoplasias. METHODS: Between February 2002 and December 2009, a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our hospital. To achieve moderate sedation, 5-7.5 mg of diazepam was administered intravenously by non-anesthesiologists. Intermittent additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was observed. All patients were classified into groups based on the required diazepam dose: low-dose (≤ 17.5 mg, n = 252) and high-dose (> 17.5 mg, n = 79). RESULTS: Differences between the low- and high-dose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons, P = 0.032), body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg, P = 0.006), tumor size (15 ± 10 vs 23 ± 18 mm, P < 0.001), lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61, P < 0.001). Multivariate analysis identified all five variables as independently related to required diazepam dosage. In terms of adverse reactions to diazepam administration, paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001). CONCLUSION: Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese, or who showed complicated lesions. PMID:22442745

  14. Providing Morphological Information for SMT Using Neural Networks

    Directory of Open Access Journals (Sweden)

    Passban Peyman

    2017-06-01

    Full Text Available Treating morphologically complex words (MCWs as atomic units in translation would not yield a desirable result. Such words are complicated constituents with meaningful subunits. A complex word in a morphologically rich language (MRL could be associated with a number of words or even a full sentence in a simpler language, which means the surface form of complex words should be accompanied with auxiliary morphological information in order to provide a precise translation and a better alignment. In this paper we follow this idea and propose two different methods to convey such information for statistical machine translation (SMT models. In the first model we enrich factored SMT engines by introducing a new morphological factor which relies on subword-aware word embeddings. In the second model we focus on the language-modeling component. We explore a subword-level neural language model (NLM to capture sequence-, word- and subword-level dependencies. Our NLM is able to approximate better scores for conditional word probabilities, so the decoder generates more fluent translations. We studied two languages Farsi and German in our experiments and observed significant improvements for both of them.

  15. Efficacy and safety of a novel submucosal lifting gel used for endoscopic submucosal dissection: a study in a porcine model

    NARCIS (Netherlands)

    Schölvinck, D. W.; Alvarez Herrero, L.; Goto, O.; Meijer, S. L.; Neuhaus, H.; Schumacher, B.; Bergman, J. J. G. H. M.; Weusten, B. L. A. M.

    2015-01-01

    Endoscopic submucosal dissection (ESD) is technically demanding. A viscous gel for submucosal lifting might induce mechanical submucosal dissection facilitating easier and safer ESD. In 12 female pigs (median 64 kg), ESDs of simulated lesions were performed at the posterior wall and greater

  16. Heading toward the right direction--solution package for endoscopic submucosal tunneling resection in the stomach.

    Directory of Open Access Journals (Sweden)

    Jiaoyang Lu

    Full Text Available The emerging submucosal tunneling and endoscopic resection (STER technique provides definitive histological diagnosis as well as a therapeutic method for the gastric submucosal tumors (SMTs. We aim to present our experience and discuss key technical issues of STER.45 patients with gastric SMTs arising from MP received STER. First, a mucosal incision was made 3 cm proximal to the tumour, a submucosal tunnel was subsequently built from the incision to the tumor. The tumor was gradually exposed and dissected from surrounding tissue and retrieved from the tunnel. The initial mucosal incision was closed by metal clips. For SMTs in the gastric fundus near cardia, the submucosal tunnel was built from lower esophagus, through the angle of His, to the tumor for resection.STER was successfully performed in 43 patients; the other two were converted to surgery. Mean operating time was 79.3 min (range 45-150 min. Mean tumor size was 1.4 cm (range 0.5-5 cm. Of the total 47 resected SMTs, 36 were GISTs, 10 were leiomyomas and 1 was schwannoma. Complete resection was achieved in all patients. Intra-procedural peumoperitoneum occurred in 3 cases because of iatrogenic perforation, no special treatment was given. 7 patients presented with mild abdominal pain/distention and fever were given antibotics. No severe post-operative complication happened. No tumor recurrence occurred in the median 11 month follow-up period.Based on short-term follow-up observation, STER is a feasible, safe and minimally invasive method for the diagnosis and treatment of small (<3 cm SMTs in gastric body, antrum and proximal cardia.

  17. English-Latvian SMT: the challenge of translating into a free word order language

    NARCIS (Netherlands)

    Khalilov, M.; Fonollosa, J.A.R.; Skadiņa, I.; Brālītis, E.; Pretkalniņa, L.

    2010-01-01

    This paper presents a comparative study of two approaches to statistical machine translation (SMT) and their application to a task of English-to-Latvian translation, which is still an open research line in the field of automatic translation. We consider a state-of-the-art phrase-based SMT and an

  18. The effect of application site of spinal manipulative therapy (SMT) on spinal stiffness.

    Science.gov (United States)

    Edgecombe, Tiffany L; Kawchuk, Greg N; Long, Cynthia R; Pickar, Joel G

    2015-06-01

    Like other factors that can influence treatment efficacy (eg, dosage, frequency, time of day), the site of treatment application is known to affect various physical interventions such as topical anesthetics and cardiopulmonary resuscitation. Like these examples, spinal manipulative therapy (SMT) is a physical intervention that may exhibit maximal benefit when directed to a specific site. Whereas numerous studies of SMT efficacy have produced mixed results, few studies have taken into account the site of SMT application. To determine if the site of SMT application modulates the effect of SMT in an anesthetized feline model. Spinal manipulative therapy applied to specific anatomic locations randomized in a Latin square design with a no-SMT control. Physiologic measures (spinal stiffness). Simulated SMT was delivered by a validated mechanical apparatus to the intact lumbar spine of eight anesthetized felines at four unique sites: L6 spinous process, left L6 lamina, left L6 mammillary process, and L7 spinous process. To measure spinal stiffness, a separate indentation load was applied mechanically to the L6 spinous process before and after each SMT application. Spinal stiffness was calculated from the resulting force-displacement curve as the average stiffness (k) and terminal instantaneous stiffness (TIS). Relative to the no-SMT control, significant decreases in spinal stiffness followed the SMT when L6 spinous and L6 lamina were used as the contact site. Terminal instantaneous stiffness significantly decreased -0.48 N/mm (upper, lower 95% confidence interval [-0.86, -0.09]) with L6 spinous as the contact site and decreased -0.44 N/mm (-0.82, -0.05), with the L6 lamina as the contact site. k increased 0.44 N/mm (-0.01, 088), using L6 spinous as the contact site. Decreases in terminal spinal stiffness were observed after SMT delivered at some application sites but not the others. The results suggest that SMT contact site modulates SMT's effect on spinal stiffness in a

  19. High-power IR laser in SMT package

    Science.gov (United States)

    Pritsch, Benedikt; Behringer, Martin; Arzberger, Markus; Wiesner, Christoph; Fehse, Robin; Heerlein, Jörg; Maric, Josip; Giziewicz, Wojciech

    2009-02-01

    Laser dies in an optical power range of 1-3 Watts are widely assembled in popular TO- packages. TO-packages suffer from high thermal resistance and limited output power. Bad thermal contact between circuit boards and TO-devices can cause overheating of laser chips, significantly reducing the operating life time. We developed a compact high heat-load SMT package for an optical power up to 7 Watts in CW operation with good life time results. The new package for high power laser chips combines highly efficient heat dissipation with Surface-mount technology. A Direct-Bonded-Copper (DBC) substrate acts as a base plate for the laser chip and heat sink. The attached frame is used for electrical contacting and acts as beam reflector where the laser light is reflected at a 45° mirror. In the application the DBC base plate of the SMT-Laser is directly soldered to a Metal-Core-PCB by reflow soldering. The overall thermal resistance from laser chip to the bottom of a MC-PCB was measured as low as 2.5 K/W. The device placement process can be operated by modern high-speed mounting equipment. The direct link between device and MC-PCB allows CW laser operation up to 6-7 watts at wavelengths of 808nm to 940nm without facing any overheating symptom like thermal roll over. The device is suitable for CW and QCW operation. In pulsed operation short rise and fall times of <2ns have been demonstrated. New application fields like infrared illumination for sensing purposes in the automotive industry and 3D imaging systems could be opened by this new technology.

  20. Preliminary test results in support of integrated EPP and SMT design methods development

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yanli [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Jetter, Robert I. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Sham, T. -L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-02-09

    The proposed integrated Elastic Perfectly-Plastic (EPP) and Simplified Model Test (SMT) methodology consists of incorporating a SMT data-based approach for creep-fatigue damage evaluation into the EPP methodology to avoid using the creep-fatigue interaction diagram (the D diagram) and to minimize over-conservatism while properly accounting for localized defects and stress risers. To support the implementation of the proposed code rules and to verify their applicability, a series of thermomechanical tests have been initiated. One test concept, the Simplified Model Test (SMT), takes into account the stress and strain redistribution in real structures by including representative follow-up characteristics in the test specimen. The second test concept is the two-bar thermal ratcheting tests with cyclic loading at high temperatures using specimens representing key features of potential component designs. This report summaries the previous SMT results on Alloy 617, SS316H and SS304H and presents the recent development on SMT approach on Alloy 617. These SMT specimen data are also representative of component loading conditions and have been used as part of the verification of the proposed integrated EPP and SMT design methods development. The previous two-bar thermal ratcheting test results on Alloy 617 and SS316H are also summarized and the new results from two bar thermal ratcheting tests on SS316H at a lower temperature range are reported.

  1. SMT3A, a human homologue of the S. cerevisiae SMT3 gene, maps to chromosome 21qter and defines a novel gene family

    Energy Technology Data Exchange (ETDEWEB)

    Lapenta, V.; Chiurazzi, P. [Catholic Univ., Rome (Italy); Van Der Spek, P.; Hanaoka, Fumio [Osaka, Univ. (Japan)] [and others

    1997-03-01

    cDNA selection was used to isolate coding sequences from cosmids mapping to the gene-rich telomeric region of human chromosome 21q. A novel cDNA, termed SMT3A, was isolated and mapped between the loci PFKL and D21S171, about 2.2 Mb proximal to the telomere. The predicted protein of 103 amino acids appears to be a homologue of the Saccharomyces cerevisiae SMT3 protein, whose gene was previously isolated as a suppressor of mutations in the MIF2 gene. The yeast MIF2 gene encodes an essential centromeric protein and shows homology to mammalian CENP-C, an integral component of active kinetochores. SMT3A was found to be highly homologous to two other recently isolated human genes, suggesting the presence of a new gene family. Homologous sequences were also found in protozoa, metazoa, and plants. Moreover, all predicted proteins show significant homology to ubiquitin. The proposed role of yeast SMT3 as centromeric protein and the strong evolutionary conservation of the SMT3A gene suggest an involvement of the encoded protein in the function and/or structure of the eukaryotic kinetochore. 30 refs., 5 figs.

  2. Relationships between phosphorus fractionation and major components in sediments using the SMT harmonised extraction procedure.

    Science.gov (United States)

    Pardo, P; López-Sánchez, J F; Rauret, G

    2003-05-01

    Leaching procedures are one of the most widely used approaches to determine phosphorus fractionation in soils and sediments. Within the framework of the Standards, Measurements and Testing programme (SMT), an extraction protocol, based on the Williams procedure, was harmonised in order to improve reproducibility among laboratories. The so called SMT protocol was then used for the certification of a reference material (BCR 684) in five phosphorus fractions: non-apatite, apatite, inorganic, organic and total phosphorus. In the present paper, the SMT protocol has been applied to sediments of different composition (organic, calcareous and Fe-rich sediments). The P, Al, Ca, Fe and Mn contents extracted in each fraction were determined. The relations among these elements and the organic matter content in the samples were studied. The results obtained support the SMT protocol as a valuable tool for the study of phosphorus fractionation in sediments.

  3. Clinical application of sodium hyaluronate,levarterenol and indicarmine solution in endoscopic submucosal dissection

    Directory of Open Access Journals (Sweden)

    Fei GAO

    2011-07-01

    Full Text Available Objective To assess the clinical value of sodium hyaluronate,levarterenol and indicarmine solution used in endoscopic submucosal dissection(ESD.Methods Sixteen patients were involved in present study who were diagnosed as precancerous lesion or submucosal tumor in digestive tract by chromoendoscopy and endoscopic ultrasonography from Nov,2010 to Feb,2011 at General Hospital of Shenyang Command.The injected solution was mixed with 0.2% indicarmine 10ml,levarterenol 10mg,sodium hyaluronate 20mg,and 0.9% normal saline 200ml.The liquid pad was formed under the submucosal layer by the injection of the mixture.Hybrid knife was employed to perform the injection,cutting and coagulation with no interruption during the procedure of ESD.Satisfactory degree was assessed,and the total solution volume,success rate,bleeding rate,perforation rate,operation duration,and length of stay in hospital were recorded.The recurrence and healing condition were observed at following-up.Results The length of lesion was 0.8~4.5cm with mean of 2.2cm.The operation duration was 45~240 min with an mean time of 95.4 min.The mean dosage of the mixed solution for submucosal injection was 102.4ml.Success rate of endoscopic submucosal dissection was 87.5%.The satisfactory degree was high.Intractable bleeding occurred in 2 cases with lateral spreading tumor(LST during the procedure,but it was controlled after high temperature coagulation without producing perforation.The dissection surface was covered by aluminum phosphate gel in all cases,and metal clips were applied in some cases for closure.The mean length of stay in hospital after ESD was 3.8 days.Conclusions The mixture of sodium hyaluronate,levarterenol,indicarmine and normal saline,when used for submucosal injection in ESD,is safe and satisfactory.

  4. Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

    Directory of Open Access Journals (Sweden)

    William Yoon

    2012-01-01

    Full Text Available Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

  5. Gastric schwannoma: a rare but important differential diagnosis of a gastric submucosal mass.

    Science.gov (United States)

    Yoon, William; Paulson, Kari; Mazzara, Paul; Nagori, Sweety; Barawi, Mohammed; Berri, Richard

    2012-01-01

    Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60-70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10-30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

  6. Submucosal esophageal hematoma precipitated by chronic idiopathic thrombocytopenic purpura

    Directory of Open Access Journals (Sweden)

    Kanika Sharma, MBBS

    2017-06-01

    Full Text Available Submucosal esophageal hematoma is an uncommon clinical entity. It can occur spontaneously or secondary to trauma, toxins, medical intervention, and in this case, coagulopathy. Management of SEH is supportive and aimed at its underlying cause. This article reports an 81-year-old male patient with chronic idiopathic thrombocytopenic purpura and hypertension that develops a submucosal esophageal hematoma.

  7. Tumorer

    DEFF Research Database (Denmark)

    Prause, J.U.; Heegaard, S.

    2005-01-01

    oftalmologi, øjenlågstumorer, conjunctivale tumorer, malignt melanom, retinoblastom, orbitale tumorer......oftalmologi, øjenlågstumorer, conjunctivale tumorer, malignt melanom, retinoblastom, orbitale tumorer...

  8. Turbo-SMT: Parallel Coupled Sparse Matrix-Tensor Factorizations and Applications.

    Science.gov (United States)

    Papalexakis, Evangelos E; Faloutsos, Christos; Mitchell, Tom M; Talukdar, Partha Pratim; Sidiropoulos, Nicholas D; Murphy, Brian

    2016-08-01

    How can we correlate the neural activity in the human brain as it responds to typed words, with properties of these terms (like 'edible', 'fits in hand')? In short, we want to find latent variables, that jointly explain both the brain activity, as well as the behavioral responses. This is one of many settings of the Coupled Matrix-Tensor Factorization (CMTF) problem. Can we enhance any CMTF solver, so that it can operate on potentially very large datasets that may not fit in main memory? We introduce Turbo-SMT, a meta-method capable of doing exactly that: it boosts the performance of any CMTF algorithm, produces sparse and interpretable solutions, and parallelizes any CMTF algorithm, producing sparse and interpretable solutions (up to 65 fold ). Additionally, we improve upon ALS, the work-horse algorithm for CMTF, with respect to efficiency and robustness to missing values. We apply Turbo-SMT to BrainQ, a dataset consisting of a (nouns, brain voxels, human subjects) tensor and a (nouns, properties) matrix, with coupling along the nouns dimension. Turbo-SMT is able to find meaningful latent variables, as well as to predict brain activity with competitive accuracy. Finally, we demonstrate the generality of Turbo-SMT, by applying it on a Facebook dataset (users, 'friends', wall-postings); there, Turbo-SMT spots spammer-like anomalies.

  9. Integrating the TRIZ and Taguchi's Method in the Optimization of Processes Parameters for SMT

    Directory of Open Access Journals (Sweden)

    Yung-Tsan Jou

    2013-01-01

    Full Text Available SMT is an assembly technology for core circuit board parts. Unless process parameters are effectively controlled, poor solderability may result in a decline in product quality. This study looks at an SMT manufacturing process in a multinational company. First, the TRIZ contradiction matrix is revised to investigate the association between the 39 parameters in the contradiction matrix and 13 parameters that influence the unevenness of solder paste in the solder paste printing process. Expert verification is then used to screen the key factors affecting the quality of SMT, which are then combined with Taguchi's method to identify the optimal parameter set influencing the thickness of SMT solder paste. Results. TRIZ identifies squeegee pressure, ejection speed, squeegee speed, and squeegee angle as the four parameters with the greatest influence on SMT solder paste thickness. Taguchi's method is used to identify the optimum levels set for the experimental factors and carry out confirmation experiments. The S/N ratio improved from 21.732 db to 26.632 db, while the mean also improved from the current 0.163 mm to 0.155 mm, close to the target value of 0.15 mm. The results show that applying TRIZ and Taguchi's method for the purpose of product improvement is feasible.

  10. Immunohistochemical detection of autotaxin (ATX)/lysophospholipase D (lysoPLD) in submucosal invasive colorectal cancer.

    Science.gov (United States)

    Kazama, Shinsuke; Kitayama, Joji; Aoki, Junken; Mori, Ken; Nagawa, Hirokazu

    2011-12-01

    Autotaxin (ATX) is molecularly identical to lysophospholipase D (lysoPLD) and is a main enzyme producing lysophosphatidic acid (LPA), which mediates a broad range of cellular responses including stimulation of cell motility. Using immunohistochemical staining, we examined the expression of ATX/lysoPLD in 98 cases of early colorectal cancer with submucosal invasion. ATX/lysoPLD was highly expressed in infiltrating cells in tumor tissue in the submucosal layer, which were characterized as mast cells. The number of ATX/lysoPLD-positive cells was significantly greater in tumors with a macroscopically depressed lesion than in tumors without depression. The density of ATX/lysoPLD-positive cells tended to have a positive correlation with microvessel vascular density (MVD), while it was not correlated with vessel invasion and nodal metastases as well as lymphovascular vessel density (LVD). Our results suggest that local production of LPA through ATX/lysoPLD may weakly correlate with formation of a depressive lesion and tumor angiogenesis in the early stage of colorectal cancer.

  11. Weak signal detection in hyperspectral imagery using sparse matrix transform (SMT) covariance estimation

    Energy Technology Data Exchange (ETDEWEB)

    Theiler, James P [Los Alamos National Laboratory; Cao, Guangzhi [PURDUE UNIV; Bouman, Charles A [PURDUE UNIV

    2009-01-01

    Many detection algorithms in hyperspectral image analysis, from well-characterized gaseous and solid targets to deliberately uncharacterized anomalies and anomlous changes, depend on accurately estimating the covariance matrix of the background. In practice, the background covariance is estimated from samples in the image, and imprecision in this estimate can lead to a loss of detection power. In this paper, we describe the sparse matrix transform (SMT) and investigate its utility for estimating the covariance matrix from a limited number of samples. The SMT is formed by a product of pairwise coordinate (Givens) rotations, which can be efficiently estimated using greedy optimization. Experiments on hyperspectral data show that the estimate accurately reproduces even small eigenvalues and eigenvectors. In particular, we find that using the SMT to estimate the covariance matrix used in the adaptive matched filter leads to consistently higher signal-to-noise ratios.

  12. Efficacy of submucosal injection of different solutions inclusive blood components on mucosa elevation for endoscopic resection

    Directory of Open Access Journals (Sweden)

    Al-Taie OH

    2012-04-01

    Full Text Available Oliver H Al-Taie1, Yildiz Bauer2, Christoph G Dietrich3, Wolfgang Fischbach21Department of Internal Medicine, Sankt Elisabeth-Hospital, Gütersloh, 2Department of Internal Medicine II, Klinikum Aschaffenburg, Aschaffenburg, 3Department of Internal Medicine, Bethlehem-Hospital, Stolberg, GermanyBackground: Endoscopic resection has become the standard treatment for noninvasive gastrointestinal malignancies. In flat mucosal tumors, normal saline is frequently used for submucosal fluid injection in order to reduce the risk of complications during endoscopic resection. Recent studies have demonstrated longer-lasting mucosa elevation by injection of agents such as hyaluronic acid or glyceol, rather than normal saline. We investigated the efficacy of different blood components in comparison with other solutions for use as a submucosal fluid cushion.Methods: Normal saline, sodium hyaluronate, glyceol, hydroxyethyl starch, serum, plasma, and whole blood were evaluated for their effectiveness in creating a submucosal cushion. One milliliter of each solution was injected into the submucosa of 5 × 5 cm specimens of resected porcine stomach. Mucosa elevation was measured before and up to 60 minutes after injection.Results: The shortest duration of mucosa elevation was observed after injection of normal saline, glyceol, and 0.125% hyaluronic acid. A significantly longer duration was obtained after injection of hydroxyethyl starch, 0.25% and 0.5% hyaluronic acid, serum, and plasma. However, whole blood generated a longer-lasting mucosa elevation than all other agents.Conclusion: The results of the current study suggest that whole blood is more effective in generating long-lasting mucosa elevation than any other commonly used solution. Because autologous blood is readily available at almost no cost, this seems to be an optimal agent for creating the mucosa elevation needed for endoscopic resection. Further in vivo studies in humans are needed to clarify the

  13. FY16 Progress Report on Test Results In Support Of Integrated EPP and SMT Design Methods Development

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yanli [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Jetter, Robert I. [RI Jetter Consulting, Pebble Beach, CA (United States); Sham, T. -L. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-08-08

    The proposed integrated Elastic Perfectly-Plastic (EPP) and Simplified Model Test (SMT) methodology consists of incorporating an SMT data-based approach for creep-fatigue damage evaluation into the EPP methodology to avoid using the creep-fatigue interaction diagram (the D diagram) and to minimize over-conservatism while properly accounting for localized defects and stress risers. To support the implementation of the proposed code rules and to verify their applicability, a series of thermomechanical tests have been initiated. This report presents the recent test results for Type 2 SMT specimens on Alloy 617, Pressurization SMT on Alloy 617, Type 1 SMT on Gr. 91, and two-bar thermal ratcheting test results on Alloy 617 with a new thermal loading profile.

  14. HNPCC-associated synchronous early-stage signet-ring cell carcinomas of colonic origin. A comparative morphological and immunohistochemical study of an intramucosal and a submucosal example

    DEFF Research Database (Denmark)

    Klarskov, Louise; Bernstein, Inge; Holck, Susanne

    2008-01-01

    synchronous early-stage SRCC, developed in a 65-year-old hereditary nonpolyposis colorectal cancer male patient with a known disease-causing mutation in MLH1. A right hemicolectomy specimen comprised a 15-mm intramucosal cecal lesion, featuring zones of conventional tubular adenoma and intraepithelial SRCC...... as well as tumor cells multifocally permeating the lamina propria and a 12-mm submucosally expanding SRCC of the ascending colon. The intramucosal and intraepithelial as well as stromal lesional cells displayed a normal membranous expression of beta-catenin and E-cadherin; submucosally infiltrating cells...

  15. Epstein-Barr Virus-Associated Lymphoepithelioma-Like Gastric Carcinoma Presenting as a Submucosal Mass: CT Findings with Pathologic Correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Won; Shin, Hyeong Cheol; Kim, Il Young; Kim, Chang Jin; Lee, Ji Hye; Lee, Chang Kyun; Jeong, Dong Jun [Soonchunhyang University Cheonan Hospital, Cheonan(Korea, Republic of)

    2010-12-15

    A lymphoepithelioma-like carcinoma, characterized by a carcinoma with heavy lymphocyte infiltration, is one of the histological patterns observed in patients with Epstein-Barr virus (EBV)-associated gastric carcinoma. Less than half of invasive carcinomas with lymphoepithelioma-like histology can grow to make a submucosal mass. These tumors generally have a better prognosis than conventional adenocarcinomas. We report a case of an EBV-associated lymphoepitheliomalike gastric carcinoma that presented as a submucosal mass on multi-detector (MD) CT and correlate them with the pathology

  16. EFFICACY OF SUBMUCOSAL DELIVERY THROUGH A PARAPHARYNGEAL APPROACH IN THE TREATMENT OF LIMITED CRICOID CHONDROMA

    Directory of Open Access Journals (Sweden)

    M.T. Khorsi Y. Amidi

    2008-05-01

    Full Text Available Cartilaginous tumors comprise 1% of all laryngeal masses. Since they grow slowly and metastasis is rare, long term survival is expected in cases of chondroma and chondrosarcoma. Thus, based on these facts and the fact that total salvage surgery after recurrence of previous tumor does not influence treatment outcomes, "Quality of Life" must be taken into great consideration. Based on 3 cases of limited condrosarcoma that we have successfully operated on using submucosal delivery through a parapharyngeal approach, after several years of recurrence free follow ups, authors determine this technique as an efficient method of approach to these tumors. Since this technique takes less time and there is no need for glottic incision and the patient is discharged in 2 days without insertion of endolaryngeal stent, we believe this method is superior to laryngofissure or total laryngectomy.

  17. Report on FY17 testing in support of integrated EPP-SMT design methods development

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yanli . [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Jetter, Robert I. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Sham, T. -L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2017-08-01

    The goal of the proposed integrated Elastic Perfectly-Plastic (EPP) and Simplified Model Test (SMT) methodology is to incorporate a SMT data-based approach for creep-fatigue damage evaluation into the EPP methodology to avoid the separate evaluation of creep and fatigue damage and eliminate the requirement for stress classification in current methods; thus greatly simplifying evaluation of elevated temperature cyclic service. The purpose of this methodology is to minimize over-conservatism while properly accounting for localized defects and stress risers. To support the implementation of the proposed methodology and to verify the applicability of the code rules, thermomechanical tests continued in FY17. This report presents the recent test results for Type 1 SMT specimens on Alloy 617 with long hold times, pressurization SMT on Alloy 617, and two-bar thermal ratcheting test results on SS316H at the temperature range of 405 °C to 705 °C. Preliminary EPP strain range analysis on the two-bar tests are critically evaluated and compared with the experimental results.

  18. Modelling and Analysis for Cyber-Physical Systems: An SMT-based approach

    DEFF Research Database (Denmark)

    Dung, Phan Anh

    Calculus has shown its potential as a domain specific language in a Smart Meter case study. Moreover, counting semantics has proven useful in connection with tool-based support for Duration Calculus. To extend SMT techniques towards better support for analysis of CPS, we proposed algorithms for handling...

  19. Guideline for Reporting Interventions on Spinal Manipulative Therapy: Consensus on Interventions Reporting Criteria List for Spinal Manipulative Therapy (CIRCLe SMT).

    Science.gov (United States)

    Groeneweg, Ruud; Rubinstein, Sidney M; Oostendorp, Rob A B; Ostelo, Raymond W J G; van Tulder, Maurits W

    2017-02-01

    The aim of the Consensus on Interventions Reporting Criteria List for Spinal Manipulative Therapy (CIRCLe SMT) study was to develop a criteria list for reporting spinal manipulative therapy (SMT). A Delphi procedure was conducted from September 2011 to April 2013 and consisted of international experts in the field of SMT. The authors formed a steering committee and invited participants, selected initial items, structured the comments of the participants after each Delphi round, and formulated the feedback. To ensure content validity, a large number of international experts from different SMT-related disciplines were invited to participate. A workshop was organized following the consensus phase, and it was used to discuss and refine the wording of the items. In total, 123 experts from 18 countries participated. These experts included clinicians (70%), researchers (93%), and academics working in the area of SMT (27%), as well as journal editors (14%). (Note: The total is more than 100% because most participants reported 2 jobs.) Three Delphi rounds were necessary to reach a consensus. The criteria list comprised 24 items under 5 domains, including (1) rationale of the therapy, (2) description of the intervention, (3) SMT techniques, (4) additional intervention/techniques, and (5) quantitative data. A valid criteria list was constructed with the aim of promoting consistency in reporting SMT intervention in scientific publications. Copyright © 2016. Published by Elsevier Inc.

  20. Human factors and usability engineering in the development of SMT-101 for the treatment of pulmonary arterial hypertension.

    Science.gov (United States)

    Noymer, Peter; Shaked, Assaf; Newell, Kay

    2018-01-22

    SMT-101, a novel, proprietary, water-resistant wearable infusion pump prefilled with a preset dosage of treprostinil, was designed to address many of the administration-related shortcomings of existing parenteral therapy for pulmonary arterial hypertension (PAH). The objective of the human factors (HF) program was to demonstrate that the SMT-101 system is safe and effective when used by patients with PAH, their caregivers, or healthcare providers. The HF program for SMT-101 consisted of 8 studies (148 participants): an ethnographic study, an online survey of patients with PAH, 4 formative studies, a study of the instructions for use (IFU), and a summative study for validation. The pump and IFU were iteratively modified using observational data and participant feedback to inform subsequent improvements throughout the HF program to optimize safe use of SMT-101 before the final study. The results of the summative study demonstrated that the design of the SMT-101 wearable, pre-filled infusion pump and IFU are safe and effective for use. In accordance with regulatory guidelines, the usability and HF aspects of SMT-101 were developed and refined through a rigorous HF program in patients with PAH and healthcare providers, which culminated in a summative study that validated the usability and use-safety of SMT-101.

  1. Body Mass Index and Clinical Outcomes from Endoscopic Submucosal Dissection of Gastric Neoplasia.

    Science.gov (United States)

    Kang, Donghoon; Ha, Sung Eun; Park, Jae Myung; Yoon, Seung Bae; Lee, Han Hee; Lim, Chul-Hyun; Kim, Jin Su; Cho, Yu Kyung; Choi, Myung-Gyu

    2017-06-01

    Association between obesity and endoscopic resection outcomes has not been investigated. We sought to determine the clinical impact of obesity in patients who underwent endoscopic submucosal dissection (ESD) for gastric neoplasia. A total of 1571 consecutive patients with gastric neoplasia who underwent ESD between December 2010 and March 2016 were enrolled in this study. We retrospectively analyzed 1181 cases that were divided into three groups based upon body mass index (BMI, kg/m(2)) according to the criteria for Asia-Pacific populations: normal (obese (≥25, n = 458). Demographics, endoscopic findings, pathologic results, and clinical outcomes were analyzed. No significant differences were observed between the three BMI groups in the following measures: the en-bloc resection rate, the complete resection rate, lymphovascular involvement or submucosal invasion of tumor cells, and adverse events. However, when comparing the obese and overweight groups with the normal group, mean procedure time was longer (P = 0.001) and the percentage of cases requiring more than 30 min, which was the overall mean procedure time, was greater (60.7, 53.2, and 50.1%, respectively; P = 0.006). The significantly associated factors with procedure durations longer than 30 min were obesity, longitudinal and circumferential location, large resection size (≥4 cm), cancer pathology, and submucosal layer invasion. In multivariate analyses, obesity was an independent predictor of long procedure time for gastric ESD. Being obese or overweight did not directly affect clinical outcomes in gastric ESD. However, obesity was significantly associated with long procedure time. Our results suggest that gastric ESD can be performed safely and effectively in obese patients.

  2. [Clinical study of SMT-Ⅱ video laryngoscope with difficult airway intubation in emergency department].

    Science.gov (United States)

    Yu, J H; Wang, Y

    2017-07-01

    Objective: To observe the clinical feasibility and security of SMT-Ⅱ video laryngoscope in difficult airway intubation in emergency department. Methods: This study took 90 adults with difficult airway who were admitted to the rescue room of Jingxi court of Beijing Chao-Yang Hospital, Capital Medical University from January 2015 to December 2016.The patients were randomly divided into 2 groups(SMT-Ⅱ video laryngoscope group: n =45, Macintosh direct laryngoscope group: n =45), which were treated with endotracheal intubation and ventilator assisted ventilation.The evaluation of difficult mask ventilation(DMV) independent risk factor score, Wlison score, Cormack-Lehane grade, mouth opening, thyromental distance, visualization of the glottis, time for laryngoscopy, time for tracheal intubation, first-pass success rate of intubation, complications, mean arterial pressure(MAP) and heart rate(HR) before induction, after laryngoscopy, after induction, after intubation 5 minutes, 10 minutes were recorded.ANOVA, t -test, Chi-square test was used to analyze differences data, respectively. Results: There was no significant difference between the two groups in terms of gender, age, height, weight and other general data, mouth opening, DMV independent risk factor score, Wlison score, and thyromental distance(χ(2)=0.045, t =-0.367, t =0.684, t =0.511, t =0.330, t =-0.724, t =1.219, t =1.034, all P >0.05). A Cormack-Lehane grade Ⅰ or Ⅱ view were 44 cases in SMT-Ⅱ video laryngoscope group and 14 cases in Macintosh direct laryngoscope group. It significantly improved with the use of SMT- Ⅱ video laryngoscope, compared with Macintosh direct laryngoscope(χ(2)=52.096, P <0.01). The time to best view was shorter in SMT-Ⅱ video laryngoscope group compared to that in Macintosh direct laryngoscope group with (15.0±1.0) seconds vs . (24.2±3.4) seconds( t =-26.319, P <0.05). The tube passage time was shorter with SMT-Ⅱ video laryngoscope (31.6±4.3) seconds vs . (12.7±0

  3. Breast Cancer Metastasis to the Stomach That Was Diagnosed after Endoscopic Submucosal Dissection

    Directory of Open Access Journals (Sweden)

    Masahide Kita

    2016-01-01

    Full Text Available A 52-year-old woman presented with stage IIB primary breast cancer (cT2N1M0, which was treated using neoadjuvant chemotherapy (epirubicin, cyclophosphamide, and paclitaxel. However, the tumor persisted in patchy areas; therefore, we performed modified radical mastectomy and axillary lymph node dissection. Routine endoscopy at 8 months revealed a depressed lesion on the gastric angle’s greater curvature, and histology revealed signet ring cell proliferation. We performed endoscopic submucosal dissection for gastric cancer, although immunohistochemistry revealed that the tumor was positive for estrogen receptor, mammaglobin, and gross cystic disease fluid protein-15 (E-cadherin-negative. Therefore, we revised the diagnosis to gastric metastasis from the breast cancer.

  4. Millimetre-wave MMIC packaging compatible with surface-mount technology (SMT)

    OpenAIRE

    Galière, J; Valard, J.L.; Estèbe, E.

    2004-01-01

    This paper presents an interconnect and packaging solution for millimetre-wave MMIC, based on collective wiring and surface mount technologies. The designed structure consists of an SMT CSP (Chip Scale Package) mounted on printed circuit board (PCB). This packaging concept has been applied to a millimetre-wave LNA and has been measured up to 60 GHz, exhibiting results close to bare die measurements (insertion loss per millimetre-wave transition lower than 0.5dB) and dem...

  5. Endoscopic submucosal dissection in the colorectum: present status and future prospects.

    Science.gov (United States)

    Uraoka, Toshio; Kawahara, Yoshiro; Kato, Jun; Saito, Yutaka; Yamamoto, Kazuhide

    2009-07-01

    Endoscopic submucosal dissection (ESD) can successfully resect early stage gastrointestinal tumors, but colorectal ESDs are not widely performed, even by Japanese endoscopists, because of several negative factors. Besides being considerably more difficult in terms of technical demands, colorectal ESDs involve a longer procedure time and have a higher complication rate compared to gastric ESDs. In addition, most colorectal lesions are adenomas or intramucosal cancers that despite their large size that can be curatively treated by endoscopic mucosal resection including piecemeal resection. There is, however, no doubt about ESD having a major therapeutic advantage in being able to achieve a higher en-bloc resection rate resulting in enhanced curability and more accurate histopathological assessment. Continued improvement in the technical skills of endoscopists, further refinement of such devices as electrical surgical knives and a special colonoscope as well as the development of more effective submucosal injection solutions and new traction systems are expected to facilitate easier, faster and safer colorectal ESD procedures in the relatively near future.

  6. Lesion isolation by circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) substantially improves en bloc resection rates for 40-mm colonic lesions.

    Science.gov (United States)

    Moss, A; Bourke, M J; Tran, K; Godfrey, C; McKay, G; Chandra, A P; Sharma, S

    2010-05-01

    En bloc resection is preferred for colonic laterally spreading tumors, but is limited to 20 mm with endoscopic mucosal resection (EMR) using normal saline submucosal injection. Our aims were to compare the efficacy and safety of circumferential submucosal incision prior to EMR (CSI-EMR) versus conventional EMR for en bloc resection of artificial lesions 40 x 40 mm in size using submucosal injection of succinylated gelatin in a porcine colon model. Two areas of normal rectosigmoid mucosa measuring 40 x 40 mm were marked with soft coagulation for en bloc resection in each of 10 pigs. By alternate allocation, one was removed with conventional snare-based EMR following submucosal injection of succinylated gelatin. The other was circumferentially incised using an insulated-tip knife, followed by submucosal succinylated gelatin injection followed by EMR of the isolated area. All procedures were performed by a single endoscopist with significant experience of EMR but none of endoscopic submucosal dissection (ESD). Euthanasia and colectomy were performed on day 10. Specimens and ex vivo colon resection sites were examined by a specialist gastrointestinal histopathologist blinded to the technique used. En bloc excision rates were 70 % for CSI-EMR vs. 0 % for conventional EMR ( P = 0.016). The median number of resections was 1 (interquartile range, IQR: 1-2) for CSI-EMR vs. 4 (3 - 6) for EMR ( P CSI-EMR vs. 37 x 32 mm for EMR ( P = 0.001). Overall procedure duration (mean +/- SD) was 30.3 +/- 19.8 minutes for CSI-EMR vs. 12.4 +/- 6.8 minutes ( P = 0.003) for EMR. The mean duration of the final 5 CSI-EMRs was 17 minutes, with a statistically significant learning effect R = -0.7, P = 0.025. No perforations or bleeding occurred. All animals were euthanased on day 10. Histologically, CSI-EMR resulted in larger specimens and deeper submucosal resections. CSI-EMR with submucosal injection of succinylated gelatin is safe and superior to conventional EMR, consistently resulting in

  7. La stimulation magnétique transcrânienne (SMT) dans la recherche fondamentale et clinique en neuroscience

    Science.gov (United States)

    Valero-Cabré, Antoni; Pascual-Leone, Alvaro; Coubard, Olivier A.

    2011-01-01

    Introduction Les méthodes de stimulation cérébrale non invasives telles que la Stimulation Magnétique Transcrânienne (SMT) sont largement utilisées pour établir des inférences causales sur les relations entre cerveau et comportement. Des applications cliniques basées sur la SMT ont également été développées pour traiter des affections neurologiques ou psychiatriques comme la dépression, la dystonie, la douleur, les acouphènes ou les séquelles d’accident vasculaire cérébral. État des connaissances La SMT fonctionne en induisant de manière non invasive et de manière focale des courants électriques dans des régions corticales, modulant ainsi leur niveau d’activité de façon variable suivant la fréquence, le nombre d’impulsions, les intervalles et la durée de stimulation utilisés. S’agissant du cortex moteur, on sait par exemple que les patterns d’impulsions de SMT à basse fréquence ou ceux délivrées de manière continue tendent à déprimer l’activité locale, tandis que la SMT à haute fréquence et discontinus tend à la potentialiser. Outre ses effets locaux, la SMT peut aussi avoir des effets à distance sur les régions cérébrales, véhiculés par les connections anatomiques et qui dépendent de l’efficacité et du signe de ces connexions. Perspectives Dans le domaine de la recherche fondamentale et des applications thérapeutiques, l’utilisation efficace de la SMT requiert, cependant, la compréhension approfondie de ses principes opérationnels, de ses risques, de ses potentialités et de ses limites. Dans cet article, nous présentons les principes par lesquels opèrent les méthodes de stimulation cérébrale non invasive, et en particulier la SMT. Conclusion À l’issue de sa lecture, le lecteur sera en mesure de discuter de façon critique les études scientifiques et cliniques utilisant la SMT, ainsi que de concevoir des applications SMT suivant une hypothèse a priori dans le domaine de la recherche en

  8. Communication between mast cells and rat submucosal neurons.

    Science.gov (United States)

    Bell, Anna; Althaus, Mike; Diener, Martin

    2015-08-01

    Histamine is a mast cell mediator released e.g. during food allergy. The aim of the project was to identify the effect of histamine on rat submucosal neurons and the mechanisms involved. Cultured submucosal neurons from rat colon express H1, H2 and H3 receptors as shown by immunocytochemical staining confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) with messenger RNA (mRNA) isolated from submucosal homogenates as starting material. Histamine evoked a biphasic rise of the cytosolic Ca(2+) concentration in cultured submucosal neurons, consisting in a release of intracellularly stored Ca(2+) followed by an influx from the extracellular space. Although agonists of all three receptor subtypes evoked an increase in the cytosolic Ca(2+) concentration, experiments with antagonists revealed that mainly H1 (and to a lesser degree H2) receptors mediate the response to histamine. In coculture experiments with RBL-2H3 cells, a mast cell equivalent, compound 48/80, evoked an increase in the cytosolic Ca(2+) concentration of neighbouring neurons. Like the response to native histamine, the neuronal response to the mast cell degranulator was strongly inhibited by the H1 receptor antagonist pyrilamine and reduced by the H2 receptor antagonist cimetidine. In rats sensitized against ovalbumin, exposure to the antigen induced a rise in short-circuit current (I sc) across colonic mucosa-submucosa preparations without a significant increase in paracellular fluorescein fluxes. Pyrilamine strongly inhibited the increase in I sc, a weaker inhibition was observed after blockade of protease receptors or 5-lipoxygenase. Consequently, H1 receptors on submucosal neurons seem to play a pivotal role in the communication between mast cells and the enteric nervous system.

  9. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts

    DEFF Research Database (Denmark)

    Deprez, P H; Bergman, J J; Meisner, S

    2010-01-01

    Endoscopic submucosal dissection (ESD) is the gold standard technique for performing en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Experience in Europe, however, is still limited and ESD is only performed in a few selected centers, with low volumes...... of cases, no description of training programs, and few published reports. In 2008, a panel of experts gathered in Rotterdam to discuss indications, training, and the wider use of ESD. The panel of experts and participants reached a consensus on five general statements: 1) ESD aims at treating mucosal...... level, and should include information on indication (Paris classification of lesion, location, and histological results prior to treatment), technique used (e.¿g. type of knife), results (en bloc and R0 resection), complications, and follow-up. The panel also agreed on minimal institutional requirements...

  10. Endoscopic Submucosal Dissection for Recurrent or Residual Superficial Esophageal Cancer after Chemoradiotherapy: Two Cases

    Science.gov (United States)

    Hwang, Changhyeok; Youn, Young Hoon; Choi, Sung-eun; Jung, Young Hak; Park, Hae Yeul; Park, Jae Jun; Kim, Jie Hyun; Park, Hyojin

    2015-01-01

    We report two cases of endoscopic submucosal dissection (ESD) for recurrent or residual esophageal squamous cell carcinoma (ESCC) lesions after chemoradiotherapy for advanced esophageal cancer. Case 1 involved a 64-year-old man who had previously undergone chemoradiotherapy for advanced ESCC and achieved a complete response (CR) for 22 months, until metachronous recurrent superficial ESCC was detected on follow-up esophagogastroduodenoscopy (EGD). We performed ESD and found no evidence of recurrence for 24 months. Case 2 involved a 59-year-old man who had previously undergone chemoradiotherapy for advanced ESCC. He responded favorably to treatment, and most of the tumor had disappeared on follow-up EGD 4 months later. However, there were two residual superficial esophageal lugol-voiding lesions. We performed ESD, and he had a CR for 32 months thereafter. ESD can be considered a viable treatment option for recurrent or residual superficial ESCC after chemoradiotherapy for advanced esophageal cancer. PMID:26668804

  11. RECONSTRUCTING PALEO-SMT POSITIONS ON THE CASCADIA MARGIN USING MAGNETIC SUSCEPTIBILITY

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Joel [Univ. of New Hampshire, Durham, NH (United States); Phillips, Stephen [Univ. of New Hampshire, Durham, NH (United States)

    2014-09-30

    Magnetic susceptibility (κ) is a mixed signal in marine sediments, representing primary depositional and secondary diagenetic processes. Production of hydrogen sulfide via anaerobic oxidation of methane (AOM) at the sulfate-methane transition (SMT) and organoclastic sulfate reduction above the SMT can result in the dissolution of iron oxides, altering κ in sediments in methane gas and gas hydrate bearing regions. We investigated records of κ on the Cascadia margin (ODP Sites 1249 and 1252; IODP Site 1325) using a Zr/Rb heavy mineral proxy from XRF core scanning to identify intervals of primary detrital magnetic susceptibility and intervals and predict intervals affected by magnetite dissolutions. We also measured total sulfur content, grain size distributions, total organic carbon (TOC) content, and magnetic mineral assemblage. The upper 100 m of Site 1252 contains a short interval of κ driven by primary magnetite, with multiple intervals (> 90 m total) of decreased κ correlated with elevated sulfur content, consistent with dissolution of magnetite and re-precipitation of pyrite. In the upper 90 m of Site 1249, κ is almost entirely altered by diagenetic processes, with much of the low κ explained by a high degree of pyritization, and some intervals affected by the precipitation of magnetic iron sulfides. At Site 1325, κ between 0-20 and 51-73 mbsf represents primary mineralogy, and in the interval 24-51 mbsf, κ may be reduced due to pyritization. This integrated approach allows for a prediction of primary κ and the amount of κ loss at each site when compared to actual κ measurements. In the case of magnetite dissolution and full pyritization, these drawdowns in κ are supported by sulfur measurements, and the exposure times of magnetite to hydrogen sulfide can be modeled. The presence of methane and methane hydrates at these sites, as well as large variations in TOC content, suggest that the past migration rates of the SMT and variation in sulfate

  12. An Unusual Endoscopic Image of a Submucosal Angiodysplasia

    Directory of Open Access Journals (Sweden)

    Rita Carvalho

    2012-01-01

    Full Text Available Obscure gastrointestinal bleeding is responsible for 2–10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia responsible for the hemorrhage.

  13. Expulsion of dominant submucosal fibroids after uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.d [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Eiers, Michael; Bellemann, Nadine; Ramsauer, Stefanie [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Rimbach, Stefan [Department of Gynecology, University of Konstanz (Germany); Kauczor, Hans-Ulrich [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Richter, Goetz M. [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Clinic of Diagnostic and Interventional Radiology, Katharinenhospital, Stuttgart (Germany)

    2010-07-15

    Purpose: Purpose of this study was to evaluate the frequency, probability, and factors associated with expulsion of submucosal fibroids after uterine artery embolization (UAE) in addition to the technical and clinical results at 1-year follow-up. Materials and methods: We determined the preinterventional volume of each dominant submucosal fibroid using the commonly used ellipsoid formula and a 3D volumetry in the MRI to define a threshold value in milliliters that indicates the probability for a fibroid expulsion. Assessment of fibroid expulsion was done by MRI at 3-month intervals for a year. Assessment of clinical mid term success was achieved by applying questionnaires at 1-year follow-up. Results: Technical success was observed in all 20 patients (mean age of 41.4 {+-} 5.6 years; range: 29.2-51.1 years). Two (10%) minor and one (5%) major complications occurred. 10/20 dominant submucosal fibroids were completely expelled during the follow-up. Using 3D MRI volumetry the preinterventional mean volume of the later expelled fibroids was 56.8 {+-} 57.0 ml (range 2.3-198.0 ml) and the mean volume of non-expelled fibroids was 123.8 {+-} 147.3 ml (range 24.0-531.8 ml). This difference was statistically significant, but weak (p = 0.0494). Fibroids with a volume equal or less than the threshold value (66.0 ml) were 73% likely to be expelled and fibroids larger than 66.0 ml were 78% likely not to be expelled. All 20 patients demonstrated a significant reduction in the fibroid related symptoms. Conclusion: In our study the complication rate was low despite increased rates of fibroid expulsion (50%); simultaneously the rate of treatment satisfaction was very high. Patients with a dominant submucosal fibroid under 66.0 ml should be informed about the probability of fibroid expulsion and the accompanying symptoms.

  14. Endoscopic submucosal dissection in Spain: outcomes and development possibilities

    Directory of Open Access Journals (Sweden)

    Juan J. Vila

    2013-10-01

    Full Text Available Endoscopic submucosal dissection (ESD allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made.

  15. Novel Adaptive Sliding Mode Control with Nonlinear Disturbance Observer for SMT Assembly Machine

    Directory of Open Access Journals (Sweden)

    Rongrong Qian

    2016-01-01

    Full Text Available This paper presents a novel adaptive sliding mode control based on nonlinear sliding surface with disturbance observer (ANSMC-DOB for precision trajectory tracking control of a surface mount technology (SMT assembly machine. A two-degree-of-freedom model with time-varying parameter uncertainties and disturbances is built to describe the first axial mode of the pick-place actuation axis of the machine. According to the principle of variable damping ratio coefficient which makes the system have a nonovershoot transient response and a short settling time in the second-order system, the nonlinear sliding surface is designed for the sliding mode control (SMC. Since the upper bound value of the disturbances is unknown, the adaptive gain estimation is applied to replace the switching gain in the SMC. In order to settle the problem of SMC unrobust to the mismatched parameter uncertainties and disturbances, the nonlinear disturbance observer is introduced to estimate the mismatched disturbances and form the novel controller of ANSMC-DOB. The stability of sliding surfaces and control laws are verified by the Lyapunov functions. The simulation research and comparative experiments are conducted to verify the improvement of positioning accuracy and robustness by the proposed ANSMC-DOB in the SMT assembly machine.

  16. Endoscopic submucosal dissection using a novel grasping type scissors forceps.

    Science.gov (United States)

    Akahoshi, K; Akahane, H; Murata, A; Akiba, H; Oya, M

    2007-12-01

    Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure that is associated with a high complication rate. The shortcoming of this method is the difficulty in fixing the knife to the target lesion. This difficulty can lead to unexpected incision, resulting in major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using an electrosurgical current. The ESD procedure using the GSF was carried out in an animal model (resected porcine stomachs in vitro). After marking the lesion and injecting a solution into the submucosa, the lesion was separated from the surrounding normal mucosa following complete incision around the lesion using the GSF. A piece of submucosal tissue was grasped and cut with the GSF using an electrosurgical current to achieve submucosal exfoliation. ESD using the GSF was carried out safely and easily without unintentional incision. ESD using GSF appears to be an easy, safe, and technically efficient method for resecting gastrointestinal neoplasms.

  17. Tumor

    Science.gov (United States)

    ... peanut plants (aflatoxins) Excessive sunlight exposure Genetic problems Obesity Radiation exposure Viruses Types of tumors known to be caused by or linked with viruses are: Cervical cancer (human papillomavirus) Most anal cancers (human papillomavirus) Some ...

  18. Short-Term Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study

    Science.gov (United States)

    Choi, Il Ju; Lee, Na Rae; Kim, Sang Gyun; Lee, Wan Sik; Park, Seun Ja; Kim, Jae J.; Lee, Jun Haeng; Kwon, Jin-Won; Park, Seung-Hee; You, Ji Hye; Kim, Ji Hyun; Lim, Chul-Hyun; Cho, Joo Young; Kim, Gwang Ha; Lee, Yong Chan; Jung, Hwoon-Yong; Kim, Ji Young; Chun, Hoon Jai; Seol, Sang-Yong

    2016-01-01

    Background/Aims Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC) that has demonstrated a minimal risk of lymph node metastasis in retrospective studies. We sought to prospectively evaluate the short-term outcomes of ESD treatment in EGCs. Methods A prospective multicenter cohort study of neoplasms 3 cm or less in diameter at endoscopic size evaluation was performed in 12 Korean ESD study group-related university hospitals and the National Cancer Center. Resected specimens were evaluated by the central pathologic review board. Results A patient cohort (n=712) with a total of 737 EGCs was analyzed. The margin-freeen bloc resection rate was 97.3%, and curative resection of 640 lesions (86.8%) was achieved. Lower curative resection rates were associated with lesions 2 to 3 cm in size prior to ESD compared with lesions 2 cm or less in size (78.6% vs 88.1%, respectively, p=0.009). Significant factors associated with noncurative resection were moderately or poorly differentiated histological type, posterior wall tumor location, tumor size larger than 3 cm, ulceration, and submucosal invasion. Delayed bleeding occurred in 49 patients (6.9%), and 12 patients (1.7%) exhibited perforations. Conclusions ESD is an effective treatment with a high curative resection rate for EGCs that meets relatively conservative pre-ESD indications. Long-term survival outcomes should be evaluated in follow-up studies. PMID:27172929

  19. Report on FY15 Alloy 617 SMT Creep-Fatigue Test Results

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yanli [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Jetter, Robert I. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Baird, Seth T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Pu, Chao [Univ. of Tennessee, Knoxville, TN (United States); Sham, Sam [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-06-22

    viability of the Alloy 617 Code Case, the use of the current elastic analysis based rules in Subsection NH for the evaluation of strain limits (a precursor for the creep-fatigue rules) and the creep-fatigue rules themselves have been deemed inappropriate for Alloy 617 at temperatures above 650C (Corum and Brass, 1991). The rationale for this exclusion is that at higher temperatures it is not feasible to decouple plasticity and creep, which is the basis for the current simplified rules. This temperature, 650C, is well below the temperature range of interest for this material for the High Temperature Gas Cooled Reactor (HTGR) as well as the VHTR. The only current alternative is, thus, a full inelastic analysis which requires sophisticated material models which have not yet been formulated and verified. To address the prohibition on the use of current methods at very high temperatures, proposed Code rules have been developed which are based on the use of elastic-perfectly plastic (E-PP) analysis methods and which are expected to be applicable to very high temperatures. To provide data to implement the proposed rules and to verify their application, a series of tests have been initiated. One test concept, the Simplified Model Test (SMT), takes into account the stress and strain redistribution in real structures by including representative follow-up characteristics in the test specimen. The correlation parameter between test and design is the elastically calculated strain, and the dependent test variable is the observed cycles to failure. Although the initial priority for the SMT approach is to generate data to support validation of the E-PP Code Case for evaluation of creep-fatigue damage, the broader goal of the SMT approach is to develop a methodology for evaluation of creep fatigue damage which is simpler to implement than the current complex rules and applicable to the full temperature range from ambient conditions to the very high temperature creep regime of 900-950C. Also

  20. DEVELOPMENT OF PREDICTIVE CONTROL STRATEGY USING SELF-IDENTIFICATION MATRIX TECHNIQUE (SMT

    Directory of Open Access Journals (Sweden)

    ABDULRAHMAN A. A.EMHEMED

    2017-07-01

    Full Text Available This article describes an easy to use predictive control strategy using selfidentification matrix technique (SMT. A description for the condition number effect for suitable tracking behaviour has been analyzed. Simple rules based on the step response of the process are applied for the proposed matrix T. A new formula is produced for the main controller tuning parameter . In the novel formula, is mainly extracted by regression analysis of first order plus dead time processes. Several plants are used to compare the proposed controller as function of the tuning parameters and tuning strategy. The effectiveness of the proposed strategy in wide ranging plants parameters has been compared with other techniques. Simulation results show that the use of the proposed strategy results in superior performance compared to previous techniques. Even though the tuning is based on approximation of actual processes with a first order plus dead time model. However, this strategy would not be suitable for systems with strong nonlinearities.

  1. The demonstration of a D-SMT stressor on Ge planer n-MOSFETs

    Directory of Open Access Journals (Sweden)

    M.-H. Liao

    2015-04-01

    Full Text Available An approximately 31% Id,sat improvement and 42% mobility enhancement are achieved on the planer Ge n-Metal-Oxide-Semiconductor Field-Effect Transistors (MOSFETs by implementing the dislocation-stress memorization technology (D-SMT stressor for the first time, based on an investigation of crystal re-growth velocities along different directions and the optimization of the dislocation angle (θ in Ge. Ultra-high stress (>3 GPa capping SiN film is found to be essential for modifying the crystal re-growth velocities along the [100] and [110] directions to optimize the θ. The change of crystal re-growth velocities and the mobility enhancement ratio with the stress along the assigned directions in Ge is also discussed, respectively.

  2. FY16 Status Report on Development of Integrated EPP and SMT Design Methods

    Energy Technology Data Exchange (ETDEWEB)

    Jetter, R. I. [R.I. Jetter Consulting, Pebble Beach, CA (United States); Sham, T. -L. [Argonne National Lab. (ANL), Argonne, IL (United States); Wang, Y. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-08-01

    The goal of the Elastic-Perfectly Plastic (EPP) combined integrated creep-fatigue damage evaluation approach is to incorporate a Simplified Model Test (SMT) data based approach for creep-fatigue damage evaluation into the EPP methodology to avoid the separate evaluation of creep and fatigue damage and eliminate the requirement for stress classification in current methods; thus greatly simplifying evaluation of elevated temperature cyclic service. The EPP methodology is based on the idea that creep damage and strain accumulation can be bounded by a properly chosen “pseudo” yield strength used in an elastic-perfectly plastic analysis, thus avoiding the need for stress classification. The original SMT approach is based on the use of elastic analysis. The experimental data, cycles to failure, is correlated using the elastically calculated strain range in the test specimen and the corresponding component strain is also calculated elastically. The advantage of this approach is that it is no longer necessary to use the damage interaction, or D-diagram, because the damage due to the combined effects of creep and fatigue are accounted in the test data by means of a specimen that is designed to replicate or bound the stress and strain redistribution that occurs in actual components when loaded in the creep regime. The reference approach to combining the two methodologies and the corresponding uncertainties and validation plans are presented. Results from recent key feature tests are discussed to illustrate the applicability of the EPP methodology and the behavior of materials at elevated temperature when undergoing stress and strain redistribution due to plasticity and creep.

  3. Using computer algebra and SMT-solvers to analyze a mathematical model of cholera propagation

    Science.gov (United States)

    Trujillo Arredondo, Mariana

    2014-06-01

    We analyze a mathematical model for the transmission of cholera. The model is already defined and involves variables such as the pathogen agent, which in this case is the bacterium Vibrio cholera, and the human population. The human population is divided into three classes: susceptible, infectious and removed. Using Computer Algebra, specifically Maple we obtain two equilibrium states: the disease free state and the endemic state. Using Maple it is possible to prove that the disease free state is locally asymptotically stable if and only if R0 1. Using the package Red-Log of the Computer algebra system Reduce and the SMT-Solver Z3Py it is possible to obtain numerical conditions for the model. The formula for the basic reproductive number makes a synthesis with all epidemic parameters in the model. Also it is possible to make numerical simulations which are very illustrative about the epidemic patters that are expected to be observed in real situations. We claim that these kinds of software are very useful in the analysis of epidemic models given that the symbolic computation provides algebraic formulas for the basic reproductive number and such algebraic formulas are very useful to derive control measures. For other side, computer algebra software is a powerful tool to make the stability analysis for epidemic models given that the all steps in the stability analysis can be made automatically: finding the equilibrium points, computing the jacobian, computing the characteristic polynomial for the jacobian, and applying the Routh-Hurwitz theorem to the characteristic polynomial. Finally, using SMT-Solvers is possible to make automatically checks of satisfiability, validity and quantifiers elimination being these computations very useful to analyse complicated epidemic models.

  4. Condyloma acuminatum of the anal canal, treated with endoscopic submucosal dissection.

    Science.gov (United States)

    Sasaki, Akiko; Nakajima, Takeshi; Egashira, Hideto; Takeda, Kotaro; Tokoro, Shinnosuke; Ichita, Chikamasa; Masuda, Sakue; Uojima, Haruki; Koizumi, Kazuya; Kinbara, Takeshi; Sakamoto, Taku; Saito, Yutaka; Kako, Makoto

    2016-02-28

    Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papilloma virus infection. Not all individuals develop persistent, progressive disease, but careful follow up is required with moderate-to-severe dysplasia to prevent progression to malignancy. Standard therapies include surgical treatments (trans-anal resection and trans-anal endoscopic microsurgery) and immunotherapeutic and topical methods (topical imiquimod); however, local recurrence remains a considerable problem. Here, we report a case with superficial CA of the anal canal, treated with endoscopic submucosal dissection (ESD). A 28-year-old man presented with a chief complaint of hematochezia. Digital exam did not detect a tumor. Screening colonoscopy revealed 10-mm long, whitish condyles extending from the anal canal to the lower rectum. The lesion covered almost the whole circumference, and only a small amount of normal mucosa remained. Magnifying endoscopy with narrow band imaging showed brownish hairpin-shaped, coiled capillaries. Although histopathological diagnosis by biopsy revealed CA, accurate histological differentiation between CA, papilloma, and squamous cell carcinoma can be difficult with a small specimen. Therefore, we performed diagnostic ESD, which provides a complete specimen for precise histopathological evaluation. The pathological diagnosis was CA, with moderate dysplasia (anal intraepithelial neoplasia 2). There was no recurrence at 16 mo after the initial ESD. Compared to surgical treatment, endoscopic diagnosis and resection could be performed simultaneously and the tumor margin observed clearly with a magnifying chromocolonoscopy, resulting in less recurrence. These findings suggest that endoscopic resection may be an alternative method for CA that prevents recurrence.

  5. Implementation of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms in Sweden

    Directory of Open Access Journals (Sweden)

    Henrik Thorlacius

    2013-01-01

    Full Text Available Objectives. Endoscopic submucosal dissection (ESD is an effective method for en bloc removal of large colorectal tumors in Japan, but this technique is not yet widely established in western countries. The purpose here was to report the experience of implementing colorectal ESD in Sweden. Methods. Twenty-nine patients with primarily nonmalignant and early colorectal neoplasms considered to be too difficult to remove en bloc with EMR underwent ESD. Five cases of invasive cancer underwent ESD due to high comorbidity excluding surgical intervention or as an unexpected finding. Results. The median age of the patients was 74 years. The median tumor size was 26 mm (range 11–89 mm. The median procedure time was 142 min (range 57–291 min. En bloc resection rate was 72% and the R0 resection rate was 69%. Two perforations occurred amounting to a perforation rate of 6.9%. Both patients with perforation could be managed conservatively. One bleeding occurred during ESD but no postoperative bleeding was observed. Conclusion. Our data confirms that ESD is an effective method for en bloc resection of large colorectal adenomas and early cancers. This study demonstrates that implementation of colorectal ESD is feasible in Sweden after proper training, careful patient selection, and standardization of the ESD procedure.

  6. Factors predicting clinical outcomes of endoscopic submucosal dissection in the rectum and sigmoid colon during the learning curve

    Science.gov (United States)

    Agapov, Mikhail; Dvoinikova, Ekaterina

    2014-01-01

    Background and study aims: Colorectal endoscopic submucosal dissection (ESD) is associated with significant technical difficulty, long procedure time, and increased risk of complications, especially perforation. This study aimed to determine the factors associated with clinical results of ESD during the learning curve. Patients and methods: In total, 44 patients with sessile and flat rectal and sigmoid colon lesions underwent ESD from November 2009 to September 2013. The procedure time, resection method, tumor size, location, gross morphology, presence of fibrosis, histologic findings, rates of en bloc and piecemeal resections and perforation were analyzed. The ESD procedure was classified as technically difficult in the case of procedure time > 120 minutes and/or piecemeal resection. The whole study time was divided into two periods: first period: resections 1 – 22, second period: resections 23 – 44. Results: En bloc and R0 resection have been achieved in 84.1 % of lesions. The mean procedure time was 119.95 ± 11.22 minutes (range 25 – 360 minutes). Perforation was seen in five cases (11.4 %). A larger tumor size was a risk factor for difficult ESD (P = 0.0001). A finding of fibrosis was a risk factor for piecemeal ESD (P = 0.0074), and perforation (P = 0.0012). There was a high direct positive correlation between tumor size and operation time (r = 0.83, P < 0.0001, 0.95 and 0.99 confidence interval for rho 0.71 – 0.904). There was no significant difference between the first and second period in terms of mean procedure time, en bloc resection or complication rate. Conclusion: A larger tumor size was associated with technically difficult ESD. Severe submucosal fibrosis was a risk factor for both piecemeal resection and perforation. PMID:26135099

  7. Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions.

    Science.gov (United States)

    Pioche, Mathieu; Mais, Laetitia; Guillaud, Olivier; Hervieu, Valérie; Saurin, Jean-Christophe; Ponchon, Thierry; Lepilliez, Vincent

    2013-12-01

    Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20  mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD. We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS.  11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm(2). Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9/11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4/11 patients (36.4%) with resolution after 1-5 dilations. Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video).

    Science.gov (United States)

    Yoshida, Masao; Takizawa, Kohei; Suzuki, Sho; Koike, Yoshiki; Nonaka, Satoru; Yamasaki, Yasushi; Minagawa, Takeyoshi; Sato, Chiko; Takeuchi, Chihiro; Watanabe, Ko; Kanzaki, Hiromitsu; Morimoto, Hiroyuki; Yano, Takafumi; Sudo, Kosuke; Mori, Keita; Gotoda, Takuji; Ono, Hiroyuki

    2017-12-09

    The aim of this study was to clarify whether dental floss clip (DFC) traction improves the technical outcomes of endoscopic submucosal dissection (ESD). A superiority, randomized control trial was conducted at 14 institutions across Japan. Patients with single gastric neoplasm meeting the indications of the Japanese guidelines for gastric treatment were enrolled and assigned to receive conventional ESD or DFC traction-assisted ESD (DFC-ESD). Randomization was performed according to a computer-generated random sequence with stratification by institution, tumor location, tumor size, and operator experience. The primary endpoint was ESD procedure time, defined as the time from the start of the submucosal injection to the end of the tumor removal procedure. Between July 2015 and September 2016, 640 patients underwent randomization. Of these, 316 patients who underwent conventional ESD and 319 patients who underwent DFC-ESD were included in our analysis. The mean ESD procedure time was 60.7 and 58.1 minutes for conventional ESD and DFC-ESD, respectively (P = .45). Perforation was less frequent in the DFC-ESD group (2.2% vs .3%, P = .04). For lesions located in the greater curvature of the upper or middle stomach, the mean procedure time was significantly shorter in the DFC-ESD group (104.1 vs 57.2 minutes, P = .01). Our findings suggest that DFC-ESD does not result in shorter procedure time in the overall patient population, but it can reduce the risk of perforation. When selectively applied to lesions located in the greater curvature of the upper or middle stomach, DFC-ESD provides a remarkable reduction in procedure time. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  9. Granularcelletumor i colon--Abrikossoffs tumor

    DEFF Research Database (Denmark)

    Eriksen, Jens Ravn; Ibsen, Per; Gyrtrup, Hans Jørgen

    2006-01-01

    A 50-year-old woman had a right hemicoletomy due to a large sessile polyp in the ascending colon, inappropriate for polypectomy. Histopathologic examination of the specimen showed a tubulovillous adenoma with moderate dysplasia and an adjacent 1 x 1 cm submucosal tumor classified as a benign GCT...

  10. The Physiological Role of Tumor Necrosis Factor in Human Immunity and Its Potential Implications in Spinal Manipulative Therapy: A Narrative Literature Review.

    Science.gov (United States)

    Zhang, Liang; Yao, Chao Hua

    2016-09-01

    Although tumor necrosis factor (TNF) is a well-known inflammatory cytokine in the pathological development of various human diseases, its physiological roles are not widely understood nor appreciated. The molecular mechanisms underlying spinal manipulation therapy (SMT) remain elusive. The relationship between TNF and SMT is unclear. Thus, we performed this literature review to better understand TNF physiology and its potential relationship with SMT, and we propose a novel mechanism by which SMT may achieve clinical benefits by using certain beneficial features of TNF. We searched several databases for relevant articles published between 1975 and 2015 and then reexamined the studies from current immunophysiological perspectives. The history and recent progresses in TNF physiology research were explored. Conflicting reports on the relationship between TNF and SMT were identified. Based on the newly discovered interaction between TNF and regulatory T cells, we proposed a putative biphasic TNF response to SMT, which may resolve the conflicts in the reported observations and interpretations. The current literature about TNF informed our discussion of new physiological roles for TNF, which may help to better understand the physiological effects of SMT.

  11. Imposing Constraints from the Source Tree on ITG Constraints for SMT

    Science.gov (United States)

    Yamamoto, Hirofumi; Okuma, Hideo; Sumita, Eiichiro

    In the current statistical machine translation (SMT), erroneous word reordering is one of the most serious problems. To resolve this problem, many word-reordering constraint techniques have been proposed. Inversion transduction grammar (ITG) is one of these constraints. In ITG constraints, target-side word order is obtained by rotating nodes of the source-side binary tree. In these node rotations, the source binary tree instance is not considered. Therefore, stronger constraints for word reordering can be obtained by imposing further constraints derived from the source tree on the ITG constraints. For example, for the source word sequence { a b c d }, ITG constraints allow a total of twenty-two target word orderings. However, when the source binary tree instance ((a b) (c d)) is given, our proposed “imposing source tree on ITG” (IST-ITG) constraints allow only eight word orderings. The reduction in the number of word-order permutations by our proposed stronger constraints efficiently suppresses erroneous word orderings. In our experiments with IST-ITG using the NIST MT08 English-to-Chinese translation track's data, the proposed method resulted in a 1.8-points improvement in character BLEU-4 (35.2 to 37.0) and a 6.2% lower CER (74.1 to 67.9%) compared with our baseline condition.

  12. Gastric bronchogenic cyst presenting as a submucosal mass: a case report

    Directory of Open Access Journals (Sweden)

    Seddik Hassan

    2012-08-01

    Full Text Available Abstract Introduction Bronchogenic cysts are developmental anomalies of the primitive foregut which mostly occur in the lung. Gastric bronchogenic cysts are extremely rare; few cases have been reported in the literature and the diagnosis was often made following surgical resection. Case presentation A 40-year-old North African man was admitted to our hospital with a gastric submucosal mass. An endoscopic ultrasound revealed a unilocular cystic mass located in the muscular layer. Its content was echogenic suggestive of mucus. Magnetic resonance imaging confirmed the liquid nature of the cyst and showed a high ratio of proteins. Based on these observations, the diagnosis of bronchogenic cyst was confirmed. An endoscopic monitoring was decided rather than surgery because of the small size of the cyst and the absence of symptoms. Conclusion Although gastric bronchogenic cysts are rare, they should be well known and considered in all differential diagnoses of gastric tumors. We report a new case of gastric bronchogenic cyst and highlight the contribution of morphological tests that currently allow a non-invasive diagnosis.

  13. Identification of sumoylation targets, combined with inactivation of SMT3, reveals the impact of sumoylation upon growth, morphology, and stress resistance in the pathogen Candida albicans.

    Science.gov (United States)

    Leach, Michelle D; Stead, David A; Argo, Evelyn; Brown, Alistair J P

    2011-03-01

    Posttranslational modifications of proteins play critical roles in the control of cellular differentiation, development, and environmental adaptation. In particular, the covalent attachment of the small ubiquitin-like modifier, SUMO, to target proteins (sumoylation) regulates cell cycle progression, transcription, nucleocytoplasmic transport, and stress responses. Here we combine proteomic, molecular, and cellular approaches to examine the roles of sumoylation in the major fungal pathogen of humans, Candida albicans. Using an N-terminally FLAG-tagged SUMO, 31 sumoylated proteins were identified in C. albicans with roles in stress responses (e.g., Hsp60, Hsp70 family members, Hsp104), the cytoskeleton and polarized growth (e.g., Tub1, Cct7, Mlc1), secretion, and endocytosis (e.g., Lsp1, Sec24, Sec7). The output from this proteomic screen was entirely consistent with the phenotypes of C. albicans mutants in which the single SUMO-encoding locus (SMT3) was inactivated or down-regulated. C. albicans smt3/smt3 cells displayed defects in growth, morphology, cell separation, nuclear segregation, and chitin deposition, suggesting important roles for sumoylation in cell cycle control. Smt3/smt3 cells also displayed sensitivity to thermal, oxidative, and cell wall stresses as well as to the antifungal drug caspofungin. Mutation of consensus sumoylation sites in Hsp60 and Hsp104 affected the resistance of C. albicans to thermal stress. Furthermore, signaling via the cell integrity pathway was defective in C. albicans smt3/smt3 cells. These observations provide mechanistic explanations for many of the observed phenotypic effects of Smt3 inactivation upon C. albicans growth and environmental adaptation. Clearly sumoylation plays key roles in fundamental cellular processes that underpin the pathogenicity of this medically important fungus.

  14. Colorectal Mesenchymal Tumor: A Clinicopathologic Study of 25 Cases

    Directory of Open Access Journals (Sweden)

    Chen-Hui Lee

    2005-07-01

    Conclusion: Two clinicopathologically different categories were identified from our colorectal mesenchymal tumors: intramural GISTs and polypoid submucosal leiomyomas. Our study suggests that GIST is a better categorization than smooth muscle tumor because of the malignant potential. Prognosis is strictly related to the number of mitoses. However, tumor size, nuclear atypia and tumor necrosis are probably also significant predictive factors of lethality. Future studies with DNA analysis and larger patient numbers are essential to evaluate the prognostic significance of our findings.

  15. A Case of Giant Colonic Muco-submucosal Elongated Polyps Associated with Intussusception

    Directory of Open Access Journals (Sweden)

    Joo Heon Kim

    2016-11-01

    Full Text Available Colonic muco-submucosal elongated polyp (CMSEP, a newly categorized non-neoplastic colorectal polyp, is a pedunculated and elongated polyp composed of normal mucosal and submucosal layers without any proper muscle layer. We herein report a giant variant of CMSEP associated with intussusception in the rectosigmoid colon, with a review of the literature. A 48-year-old woman underwent a laparoscopic low anterior resection due to multiple large submucosal polypoid masses associated with intussusception. Grossly, the colonic masses were multiple pedunculated polyps with a long stalk and branches ranging in size from a few millimeters to 14.0 cm in length. Microscopically, there was no evidence of hyperplasia, atypia, or active inflammation in the mucosa. The submucosal layers were composed of edematous and fibrotic stroma with fat tissue, dilated vessels, and lymphoid follicles.

  16. Temporary preservation of avulsed tooth in oral submucosal tissue: an experimental study in cat.

    Science.gov (United States)

    Jamalpour, Mohammad Reza; Soltanian, Ali Reza; Tootunchi, Amir Sasan; Roshanipaian, Milad

    2014-08-01

    The purpose of this study was to determine the ability of oral submucosal tissue to serve as a temporary storage medium for the maintenance of periodontal ligament (PDL) cell viability of avulsed teeth. Thirty cats were divided into five groups. After extraction of three teeth in each cat, one tooth was put in the depth of cat's oral submucosal tissue and the other two teeth were put in Hanks' balanced salt solution (HBSS) and tap water. The teeth were removed after 8, 24, 48, 72, and 168 h from their mediums and sent for laboratory processing and counting of vital periodontal cells. Statistical analysis demonstrated that submucosal tissue kept PDL cells viable as good as HBSS. This animal study showed that the efficacy of oral submucosal tissue in maintaining the viability of human PDL cells is similar to that of HBSS. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Role of narrow band imaging in endoscopic submucosal dissection

    Science.gov (United States)

    Nonaka, Kouichi; Nishimura, Makoto; Kita, Hiroto

    2012-01-01

    Narrow band imaging (NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces, allowing improved visualization of mucosal surface structures. Studies have progressed over the last several years, and the clinical usefulness has been demonstrated. NBI has become frequently applied for preoperative diagnosis before endoscopic submucosal dissection (ESD) of digestive tract cancers, as well as for assessment of the range of ESD for en-bloc resection of large lesions. Consensus has been reached with regard to the usefulness of NBI for detecting micro-lesions of esophageal squamous cell carcinoma indicated for ESD, for the diagnosis of the range and depth. NBI has also been attracting attention for diagnosing gastric cancer based on the observation of micro blood vessels on the mucosal surface and mucosal surface microstructures. The usefulness of NBI has been reported in relation to various aspects of colon cancer, including diagnoses of the presence, quality, range, and depth of lesions. However, as NBI has not surpassed diagnostic methods based on magnifying observation combined with the established and widely employed dye method, its role in ESD is limited at present. Although NBI is very useful for the diagnosis of digestive tract cancers, comprehensive endoscopic diagnosis employing the combination of conventional endoscopy including dye spraying, EUS, and NBI may be important and essential for ESD. PMID:23125896

  18. Phonosurgical resection using submucosal infusion technique for precancerous laryngeal leukoplakia.

    Science.gov (United States)

    Kono, Takeyuki; Saito, Koichiro; Yabe, Haruna; Ogawa, Kaoru

    2017-01-01

    This study was designed to assess the feasibility of the submucosal infusion technique combined with microflap dissection as a radical therapeutic and diagnostic option for precancerous laryngeal leukoplakia. Retrospective study. Severe dysplasia or carcinoma in situ was diagnosed after phonomicrosurgical dissections in 25 patients with unilateral laryngeal leukoplakia. Of these, 15 patients preferred no additional surgery (observation group), whereas 10 patients underwent further laser subligamental cordectomy (additional surgery group). The relationship between the initial surgical margin and histopathological characteristics of additionally excised tissues was assessed to evaluate diagnostic reliability. Disease control was assessed to determine the oncologic efficacy of the therapeutic procedure. Comparative multidimensional vocal assessments were performed in both groups to evaluate functional advantages of one-stage excision. After the initial phonomicrosurgical resection, three patients had residual dysplastic lesions near the vocal process and anterior commissure, whereas three other patients had lesions suspicious for recurrence. No postoperative malignant transformation was observed in any patient. Although well-preserved vocal function was observed in the observation group, vocal quality deteriorated shortly after laser surgery in the additional surgery group. Regarding acoustics, aerodynamics, and quality-of-life evaluations, statistically equivalent scores were observed between the observation and control groups, whereas scores were inferior in the additional surgery group than in the control group. Phonomicrosurgical resection may be a therapeutic option with oncologic efficacy against precancerous laryngeal leukoplakia. This radical management might achieve more satisfactory postoperative vocal function. NA Laryngoscope, 127:153-158, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Microbial Population Differentials between Mucosal and Submucosal Intestinal Tissues in Advanced Crohn's Disease of the Ileum.

    Directory of Open Access Journals (Sweden)

    Rodrick J Chiodini

    Full Text Available Since Crohn's disease is a transmural disease, we hypothesized that examination of deep submucosal tissues directly involved in the inflammatory disease process may provide unique insights into bacterial populations transgressing intestinal barriers and bacterial populations more representative of the causes and agents of the disease. We performed deep 16s microbiota sequencing on isolated ilea mucosal and submucosal tissues on 20 patients with Crohn's disease and 15 non-inflammatory bowel disease controls with a depth of coverage averaging 81,500 sequences in each of the 70 DNA samples yielding an overall resolution down to 0.0001% of the bacterial population. Of the 4,802,328 total sequences generated, 98.9% or 4,749,183 sequences aligned with the Kingdom Bacteria that clustered into 8545 unique sequences with <3% divergence or operational taxonomic units enabling the identification of 401 genera and 698 tentative bacterial species. There were significant differences in all taxonomic levels between the submucosal microbiota in Crohn's disease compared to controls, including organisms of the Order Desulfovibrionales that were present within the submucosal tissues of most Crohn's disease patients but absent in the control group. A variety of organisms of the Phylum Firmicutes were increased in the subjacent submucosa as compared to the parallel mucosal tissue including Ruminococcus spp., Oscillospira spp., Pseudobutyrivibrio spp., and Tumebacillus spp. In addition, Propionibacterium spp. and Cloacibacterium spp. were increased as well as large increases in Proteobacteria including Parasutterella spp. and Methylobacterium spp. This is the first study to examine the microbial populations within submucosal tissues of patients with Crohn's disease and to compare microbial communities found deep within the submucosal tissues with those present on mucosal surfaces. Our data demonstrate the existence of a distinct submucosal microbiome and ecosystem

  20. Submucosal fibroids becoming endocavitary following uterine artery embolization: risk assessment by MRI.

    Science.gov (United States)

    Verma, Sachit K; Bergin, Diane; Gonsalves, Carin F; Mitchell, Donald G; Lev-Toaff, Anna S; Parker, Laurence

    2008-05-01

    The purpose of our study was to assess the relationship between the endometrium and submucosal fibroids before and after uterine artery embolization (UAE). Contrast-enhanced pelvic 1.5-T MRI was performed in 49 women before and after UAE over a 2-year period. Dominant (largest diameter) fibroids in intramural, submucosal, subserosal, pedunculated subserosal, and endocavitary locations were assessed on pre- (baseline) and postembolization MRI. Size, locations of dominant fibroids relative to endometrium and serosa before and after embolization were compared. The ratio between the largest endometrial interface and the maximum dimension of the dominant submucosal fibroid (interface-dimension ratio) was determined on baseline MRI. The infarction rate for dominant fibroids was estimated after UAE. One hundred forty dominant fibroids were identified on baseline MRI. Forty-nine (35%) were intramural, 39 (28%) were submucosal, 34 (24%) were subserosal, eight (6%) were pedunculated subserosal, and 10 (6%) were endocavitary in location on preembolization MRI. After UAE, of 39 dominant submucosal fibroids, 13 (33%) became endocavitary: complete (n = 4), partial (n = 9) on the basis of European Society of Gynaecological Endoscopy (ESGE) classification. The preembolization mean interface-dimension ratio and mean diameters for dominant fibroids that became endocavitary were significantly greater than for those that did not become endocavitary after embolization (0.65 vs 0.32, p fibroids showed 100% infarction after UAE. Submucosal fibroids with an interface-dimension ratio of greater than 0.55 are more likely to migrate into the endometrial cavity after UAE. The majority of these are expelled spontaneously without significant symptoms. Rarely, submucosal fibroids greater than 6 cm in size that become endocavitary may cause postprocedural complications requiring further intervention and medical treatment.

  1. Hemorragia digestiva por tumor estromal gástrico

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    Francisco de Souza Consolo

    Full Text Available Gastrointestinal stromal tumors account for 0.1 to 3% of all resected gastric tumors and are the most common submucosal mass found in the stomach. Preoperative diagnosis is often difficult; consequently surgery is the best and only option on most cases. There are studies with different surgery techniques based on tumors location. The reported case led us at literature review with the intent of establishing preoperative diagnosis, therapeutic strategies and prognosis.

  2. Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection

    Science.gov (United States)

    Suzuki, Haruhisa; Oda, Ichiro; Sekiguchi, Masau; Abe, Seiichiro; Nonaka, Satoru; Yoshinaga, Shigetaka; Nakajima, Takeshi; Saito, Yutaka

    2015-01-01

    AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection (ESD). METHODS: A total of 4943 early gastric cancer (EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time. RESULTS: Delayed perforation occurred in 7 (0.1%) cases. The median time until the occurrence of delayed perforation was 11 h (range, 6-172 h). Three (43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d (range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases (OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation. CONCLUSION: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complication effectively and promptly. PMID:26640340

  3. The role of immunohistochemistry in the detection of vascular invasion in specimens of endoscopic submucosal dissection

    Directory of Open Access Journals (Sweden)

    Nayze Lucena Sangreman Aldeman

    2013-08-01

    Full Text Available INTRODUCTION: Endoscopic submucosal dissection (ESD of early neoplasias of the gastrointestinal tract (GIT has been increasingly applied as an alternative to invasive surgical procedures, with the aim to preserve the patient's organ and quality of life, although it does not allow the histopathological analysis of lymph nodes. Previous studies demonstrated that the presence of neoplastic emboli in lymphatic (lymphatic vascular invasion [LVI] or blood vessels (blood vascular invasion [BVI] is considered a positive predictive factor for the occurrence of lymph node metastasis. The assessment of vascular invasion carried out only by routine hematoxylin and eosin staining (HE may yield both falsepositive and false-negative results. D2-40 is a specific monoclonal antibody to the lymphatic endothelium. Thus, it is useful for identifying LVI and distinguishing if tumor embolization is found in blood or lymphatic vessels. OBJECTIVE: To determine the role of immunohistochemistry (IHC in the assessment of ESD specimens by comparing the detection of LVI and BVI by HE and IHC with D2-40 and CD34 immunolabeling. METHOD: We conducted the IHC study using D2-40 and CD34 markers (pan-endothelial in 30 cases of ESD with histological diagnosis of carcinoma in order to assess the presence of LVI and BVI. RESULTS: The detection of LVI was more prevalent than BVI. Three out of six cases with LVI were false-positive by HE and six were false-negative by IHC. Regarding BVI, five cases were identified and one was false-negative by IHC. CONCLUSION: Our results indicated that the histopathological analysis of ESD specimens by exclusively routine HE staining does not allow proper evaluation of BVI or LVI.

  4. Endoscopic submucosal dissection training with ex vivo human gastric remnants.

    Science.gov (United States)

    Pham, David V; Shah, Anand; Borao, Frank J; Gorcey, Steven

    2014-01-01

    Endoscopic submucosal dissection (ESD) offers en bloc resection of early cancer or precancerous lesions, potentially saving patients from major organ resection, such as gastrectomy, colectomy, and esophagectomy. Japan now leads the world in ESD due to its high rate of gastric cancer. Western countries, with their lower gastric cancer rates, do not get as much experience with the technique. Training in ESD utilizing both in vivo and ex vivo porcine stomach has been shown to decrease rates of perforation and operative time. Both models can be prohibitively expensive or not generally available to the majority of endoscopists on a regular basis. This study describes the framework for using human gastric remnants from sleeve gastrectomy patients for ESD training. Patients undergoing sleeve gastrectomy for morbid obesity were consented for use of their gastric specimen before surgery. The specimen was weighed and measured by the pathologist and then used for ESD training. The specimen was mounted to a 15-mm laparoscopic port and secured using a pursestring suture. ESD was then performed through this port. We were able to successfully use this model to resect multiple marked out lesions in an en bloc fashion. Training using this model has improved our dissection times from approximately 2 h to 30 min for a 2-cm simulated lesion. ESD requires the endoscopist to perform a surgical dissection. Until now, development of these skills required intensive training on porcine models that are not widely available. We were able to create a method using the excised portion from sleeve gastrectomy patients, providing a more accessible and cost-effective model for ESD training and potentially other endoscopic therapeutic modalities.

  5. Increased myoepithelial cells of bronchial submucosal glands in fatal asthma.

    Science.gov (United States)

    Green, F H Y; Williams, D J; James, A; McPhee, L J; Mitchell, I; Mauad, T

    2010-01-01

    Fatal asthma is characterised by enlargement of bronchial mucous glands and tenacious plugs of mucus in the airway lumen. Myoepithelial cells, located within the mucous glands, contain contractile proteins which provide structural support to mucous cells and actively facilitate glandular secretion. To determine if myoepithelial cells are increased in the bronchial submucosal glands of patients with fatal asthma. Autopsied lungs from 12 patients with fatal asthma (FA), 12 patients with asthma dying of non-respiratory causes (NFA) and 12 non-asthma control cases (NAC) were obtained through the Prairie Provinces Asthma Study. Transverse sections of segmental bronchi from three lobes were stained for mucus and smooth muscle actin and the area fractions of mucous plugs, mucous glands and myoepithelial cells determined by point counting. The fine structure of the myoepithelial cells was examined by electron microscopy. FA was characterised by significant increases in mucous gland (p = 0.003), mucous plug (p = 0.004) and myoepithelial cell areas (p = 0.017) compared with NAC. When the ratio of myoepithelial cell area to total gland area was examined, there was a disproportionate and significant increase in FA compared with NAC (p = 0.014). Electron microscopy of FA cases revealed hypertrophy of the myoepithelial cells with increased intracellular myofilaments. The NFA group showed changes in these features that were intermediate between the FA and NAC groups but the differences were not significant. Bronchial mucous glands and mucous gland myoepithelial cell smooth muscle actin are increased in fatal asthma and may contribute to asphyxia due to mucous plugging.

  6. Safety, Tolerability, and Pharmacokinetics of SMT C1100, a 2-Arylbenzoxazole Utrophin Modulator, following Single- and Multiple-Dose Administration to Pediatric Patients with Duchenne Muscular Dystrophy.

    Directory of Open Access Journals (Sweden)

    Valeria Ricotti

    Full Text Available SMT C1100 is a utrophin modulator being evaluated as a treatment for Duchenne muscular dystrophy (DMD. This study, the first in pediatric DMD patients, reports the safety, tolerability and PK parameters of single and multiple doses of SMT C1100, as well as analyze potential biomarkers of muscle damage.This multicenter, Phase 1 study enrolled 12 patients, divided equally into three groups (A-C. Group A were given 50 mg/kg on Days 1 and 11, and 50 mg/kg bid on Days 2 to 10. Group B and C received 100 mg/kg on Days 1 and 11; Group B and Group C were given 100 mg/kg bid and 100 mg/kg tid, respectively, on Days 2 to 10. A safety review was performed on all patients following the single dose and there was at least 2 weeks between each dose escalation, for safety and PK review. Adverse events (AEs were monitored throughout the study.Most patients experienced mild AEs and there were no serious AEs. Two patients required analgesia for pain (headache, ear pain and toothache. One patient experienced moderate psychiatric AEs (abnormal behaviour and mood swings. Plasma concentrations of SMT C1100 at Days 1 and 11 indicated a high degree of patient variability regardless of dose. Unexpectedly the SMT C1100 levels were significantly lower than similar doses administered to healthy volunteers in an earlier clinical study. In general, individual baseline changes of creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase levels fell with SMT C1100 dosing.SMT C1100 was well tolerated in pediatric DMD patients.ClinicalTrials.gov NCT02383511.

  7. Safety, Tolerability, and Pharmacokinetics of SMT C1100, a 2-Arylbenzoxazole Utrophin Modulator, following Single- and Multiple-Dose Administration to Pediatric Patients with Duchenne Muscular Dystrophy.

    Science.gov (United States)

    Ricotti, Valeria; Spinty, Stefan; Roper, Helen; Hughes, Imelda; Tejura, Bina; Robinson, Neil; Layton, Gary; Davies, Kay; Muntoni, Francesco; Tinsley, Jonathon

    2016-01-01

    SMT C1100 is a utrophin modulator being evaluated as a treatment for Duchenne muscular dystrophy (DMD). This study, the first in pediatric DMD patients, reports the safety, tolerability and PK parameters of single and multiple doses of SMT C1100, as well as analyze potential biomarkers of muscle damage. This multicenter, Phase 1 study enrolled 12 patients, divided equally into three groups (A-C). Group A were given 50 mg/kg on Days 1 and 11, and 50 mg/kg bid on Days 2 to 10. Group B and C received 100 mg/kg on Days 1 and 11; Group B and Group C were given 100 mg/kg bid and 100 mg/kg tid, respectively, on Days 2 to 10. A safety review was performed on all patients following the single dose and there was at least 2 weeks between each dose escalation, for safety and PK review. Adverse events (AEs) were monitored throughout the study. Most patients experienced mild AEs and there were no serious AEs. Two patients required analgesia for pain (headache, ear pain and toothache). One patient experienced moderate psychiatric AEs (abnormal behaviour and mood swings). Plasma concentrations of SMT C1100 at Days 1 and 11 indicated a high degree of patient variability regardless of dose. Unexpectedly the SMT C1100 levels were significantly lower than similar doses administered to healthy volunteers in an earlier clinical study. In general, individual baseline changes of creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase levels fell with SMT C1100 dosing. SMT C1100 was well tolerated in pediatric DMD patients. ClinicalTrials.gov NCT02383511.

  8. Submucosal neurons and enteric glial cells expressing the P2X7 receptor in rat experimental colitis.

    Science.gov (United States)

    da Silva, Marcos Vinícius; Marosti, Aline Rosa; Mendes, Cristina Eusébio; Palombit, Kelly; Castelucci, Patricia

    2017-06-01

    The aim of this study was to evaluate the effect of ulcerative colitis on the submucosal neurons and glial cells of the submucosal ganglia of rats. 2,4,6-Trinitrobenzene sulfonic acid (TNBS; colitis group) was administered in the colon to induce ulcerative colitis, and distal colons were collected after 24h. The colitis rats were compared with those in the sham and control groups. Double labelling of the P2X7 receptor with calbindin (marker for intrinsic primary afferent neurons, IPANs, submucosal plexus), calretinin (marker for secretory and vasodilator neurons of the submucosal plexus), HuC/D and S100β was performed in the submucosal plexus. The density (neurons per area) of submucosal neurons positive for the P2X7 receptor, calbindin, calretinin and HuC/D decreased by 21%, 34%, 8.2% and 28%, respectively, in the treated group. In addition, the density of enteric glial cells in the submucosal plexus decreased by 33%. The profile areas of calbindin-immunoreactive neurons decreased by 25%. Histological analysis revealed increased lamina propria and decreased collagen in the colitis group. This study demonstrated that ulcerative colitis affected secretory and vasodilatory neurons, IPANs and enteric glia of the submucosal plexus expressing the P2X7 receptor. Copyright © 2017 Elsevier GmbH. All rights reserved.

  9. Light- and electron microscopical studies of interstitial cells of Cajal and muscle cells at the submucosal border of human colon

    DEFF Research Database (Denmark)

    Rumessen, J J; Peters, S; Thuneberg, L

    1993-01-01

    It has been suggested that interstitial cells of Cajal (ICC) at the submucosal border of the colonic circular muscle are pacemaker cells. We studied smooth muscle cells and ICC at the submucosal surface of the circular muscle layer of the normal human colon....

  10. Microbial Population Differentials between Mucosal and Submucosal Intestinal Tissues in Advanced Crohn's Disease of the Ileum

    Science.gov (United States)

    Chiodini, Rodrick J.; Dowd, Scot E.; Chamberlin, William M.; Galandiuk, Susan; Davis, Brian; Glassing, Angela

    2015-01-01

    Since Crohn's disease is a transmural disease, we hypothesized that examination of deep submucosal tissues directly involved in the inflammatory disease process may provide unique insights into bacterial populations transgressing intestinal barriers and bacterial populations more representative of the causes and agents of the disease. We performed deep 16s microbiota sequencing on isolated ilea mucosal and submucosal tissues on 20 patients with Crohn's disease and 15 non-inflammatory bowel disease controls with a depth of coverage averaging 81,500 sequences in each of the 70 DNA samples yielding an overall resolution down to 0.0001% of the bacterial population. Of the 4,802,328 total sequences generated, 98.9% or 4,749,183 sequences aligned with the Kingdom Bacteria that clustered into 8545 unique sequences with Crohn's disease compared to controls, including organisms of the Order Desulfovibrionales that were present within the submucosal tissues of most Crohn's disease patients but absent in the control group. A variety of organisms of the Phylum Firmicutes were increased in the subjacent submucosa as compared to the parallel mucosal tissue including Ruminococcus spp., Oscillospira spp., Pseudobutyrivibrio spp., and Tumebacillus spp. In addition, Propionibacterium spp. and Cloacibacterium spp. were increased as well as large increases in Proteobacteria including Parasutterella spp. and Methylobacterium spp. This is the first study to examine the microbial populations within submucosal tissues of patients with Crohn's disease and to compare microbial communities found deep within the submucosal tissues with those present on mucosal surfaces. Our data demonstrate the existence of a distinct submucosal microbiome and ecosystem that is not well reflected in the mucosa and/or downstream fecal material. PMID:26222621

  11. Endoscopic Sealing of Bronchopleural Fistulas with Submucosal Injection of a Tissue Expander: A Novel Technique

    Directory of Open Access Journals (Sweden)

    Cayo García-Polo

    2010-01-01

    Full Text Available The occurrence of a bronchopleural fistula (BPF continues to represent a challenging management problem, and is associated with high morbidity and mortality. A novel and successful technique that uses submucosal injection of a tissue expander for bronchoscopic occlusion of BPFs has been designed. This method may be used either alone or in combination with bronchoscopic instillation of n-butyl-cyanoacrylate glue. The occlusion technique is described, with a presentation of two patients who were successfully treated with this method. The submucosal injection of a tissue expander is an effective, economical and minimally invasive technique for managing BPFs.

  12. Gastric Schwannoma Mimicking Malignant Gastrointestinal Stromal Tumor Exhibiting Increased Fluorodeoxyglucose Uptake

    OpenAIRE

    Sung Jin Oh; Byoung Jo Suh; Jong Kwon Park

    2016-01-01

    A schwannoma is a kind of neurogenic tumor that rarely occurs in the gastrointestinal tract. Gastric schwannomas make up 0.2% of all gastric neoplasms. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors and up to 60?70% of GIST occur in the stomach. Schwannoma and GIST are similar in clinical features, so they are difficult to differentiate preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST a...

  13. Proper muscle layer damage affects ulcer healing after gastric endoscopic submucosal dissection.

    Science.gov (United States)

    Horikawa, Yohei; Mimori, Nobuya; Mizutamari, Hiroya; Kato, Yuhei; Shimazu, Kazuhiro; Sawaguchi, Masayuki; Tawaraya, Shin; Igarashi, Kimihiro; Okubo, Syunji

    2015-11-01

    Endoscopic submucosal dissection (ESD) is the established therapy for superficial gastrointestinal neoplasms. However, management of the artificial ulcers associated with ESD has become important and the relationship between ulcer healing factors and treatment is still unclear. We aimed to evaluate ESD-related artificial ulcer reduction ratio at 4 weeks to assess factors associating with ulcer healing after ESD that may lead to optimal treatment. Between January 2009 and December 2013, a total of 375 lesions fulfilled the expanded criteria for ESD. We defined ulcer reduction rate Ulcer reduction rate was significantly correlated with factors related to the ESD procedure (i.e. procedure time, submucosal fibrosis, and injury of the proper muscle layer, in univariate analysis. Multivariate logistic regression analysis showed that submucosal fibrosis (F2) (P = 0.03; OR, 16.46; 95% CI, 1.31-206.73) and injury of the proper muscle layer (P = 0.01; OR, 4.27; 95% CI, 2.04-8.92) were statistically significant predictors of delayed healing. This single-center retrospective study indicated that ESD-induced artificial ulcer healing was affected by submucosal fibrosis and injury of the proper muscle layer, which induced damage to the muscle layer. Therefore, the preferable pharmacotherapy can be determined on completion of the ESD procedure. © 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

  14. Technique of endoscopic biopsy of islet allografts transplanted into the gastric submucosal space in pigs

    NARCIS (Netherlands)

    T. Fujita (Tetsuji); K.M. McGrath (Kevin); R. Bottino (Rita); E.M. Dons (Eefje); C. Long (Cassandra); G. Kumar (Goutham); B. Ekser; G.J. Echeverri (Gabriel); A. Hata (Akira); K. Haruma (Ken); D.K.C. Cooper (David); H. Hara (Hidetaka)

    2013-01-01

    textabstractCurrently, islet cells are transplanted into the liver via portal vein infusion. One disadvantage of this approach is that it is not possible to adequately biopsy the islets in the liver to assess for rejection. Islet transplantation (Tx) into the gastric submucosal space (GSMS) can be

  15. Effect of Submucosal Injection of Dexamethasone on Post-operative Sequelae of Third Molar Surgery

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    S P Deo

    2011-06-01

    Full Text Available Introduction: This study was carried out to evaluate the effects of a single pre-operative sub-mucosal injection of dexamethasone after third molar surgery to see the effects on post-operative discomfort. Methods: This study was a prospective, double-blind, randomized, clinical trial. The subjects were forty patients who underwent surgical removal of the mandibular impacted third molar under local anesthesia and after being randomly assigned to receive either an 8 mg dexamethasone as submucosal injection or a normal saline injection into the lower buccal vestibule adjacent to the third molar. The maximum interincisal distance and facial contours were measured at the baseline and post-surgically on Day 2 and 7. Post-operative pain was evaluated subjectively using a visual analog scale and objectively by counting the number of analgesic tablets used. All subjects were operated upon by the same investigator to minimize the difference from inter-operator variability. Results: There was a signicant difference in the measurements of the degree of swelling and trismus between the two groups on the 2nd post-operative day. In contrast, there was no statistically signicant difference between the groups on the 7th post-operative day. The test group also used fewer analgesics post-operatively. Conclusions: Submucosal injection of dexamethasone after third molar surgery is effective in reducing postoperative swelling and trismus. It also delays the onset of post-operative pain. Keywords: dexamethasone, submucosal injection, third molar, third molar surgery, third molar extraction

  16. Outpatient transcervical microwave myolysis assisted by transabdominal ultrasonic guidance for menorrhagia caused by submucosal myomas.

    Science.gov (United States)

    Tsuda, Akira; Kanaoka, Yasushi

    2015-01-01

    The aim of this paper was to evaluate the effectiveness in day clinics of microwave endometrial ablation (MEA) on transcervical microwave myolysis for patients with menorrhagia caused by submucosal myomas. Thirty-five outpatients (average age 44.8 ± 5.2 years (mean ± SD), range 34-58) with a single submucosal myoma that was 4-7 cm (5.5 ± 2.1 cm) in size underwent MEA with transcervical microwave myolysis using a specifically developed transabdominal ultrasound probe attachment for transcervical puncture. Primary outcomes were the changes in the blood haemoglobin level and the volume of myoma before and after the treatment. Secondary outcomes were the improvement in menorrhagia and satisfaction after the operation, assessed by visual analogue scale (VAS). The mean operation time was 27.9 ± 13.6 min. The myomas had shrunk by 56.2% at 3 months and 73.8% at ≥6 months after the operation. Blood haemoglobin levels had increased significantly at 3 months (10.2 ± 2.0 vs. 12.7 ± 1.2, p menorrhagia caused by submucosal myomas. The procedure may be an alternative to hysterectomy for menorrhagia caused by submucosal myomas in women during the perimenopausal period.

  17. Energy metabolism during the perioperative period of gastric endoscopic submucosal dissection.

    Science.gov (United States)

    Chinda, Daisuke; Shimoyama, Tadashi; Hayamizu, Shiro; Miyazawa, Kuniaki; Arai, Tetsu; Yanagimachi, Miyuki; Tsukamoto, Toshiaki; Mikami, Tatsuya; Fukuda, Shinsaku

    2017-09-01

    The aim of this study was to investigate the change in the energy metabolism and invasiveness in the perioperative period of endoscopic submucosal dissection for early gastric cancer. Fifty-two consecutive patients were enrolled into the study between July 2013 and May 2014 and examined resting energy expenditure using an indirect calorimeter, body weight and basal energy expenditure using the Harris-Benedict equation before and after endoscopic submucosal dissection. Resting energy expenditure/body weight and resting energy expenditure/basal energy expenditure were 20.2 ± 3.0 kcal/kg/day and 0.96 ± 0.11 on the day of endoscopic submucosal dissection, whereas one day after the endoscopic submucosal dissection they were 21.7 ± 3.2 kcal/kg/day and 1.03 ± 0.14, showing significant increases (penergy metabolism and stress factor using an indirect calorimeter in the perioperative period of endoscopic operation: UMIN000027135).

  18. Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy.

    Science.gov (United States)

    Nonaka, Satoru; Oda, Ichiro; Makazu, Makomo; Haruyama, Shin; Abe, Seiichiro; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Nakajima, Takeshi; Kushima, Ryoji; Saito, Yutaka

    2013-07-01

    Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line. We evaluated clinical results including long-term outcomes to determine the feasibility and effectiveness of ESD for EGC in the remnant stomach of patients after gastrectomy. Retrospective study. National Cancer Center Hospital, Tokyo, Japan. We investigated patients undergoing ESD for EGC in the remnant stomach from 1997 to 2011. We examined the patient characteristics, endoscopic findings, technical results, adverse events, and histopathologic results including curability and evaluations of Helicobacter pylori gastritis in addition to the rates of local recurrence, metachronous gastric cancer, overall survival, and cause-specific survival. A total of 128 consecutive patients with 139 lesions had previously undergone 87 distal (68%), 25 proximal (19.5%) and 16 pylorus-preserving gastrectomies (12.5%). The median period from the original gastrectomy to the subsequent ESD for EGC in the remnant stomach was 5.7 years (range 0.6-51 years), the median tumor size was 13 mm (range 1-60 mm), and the median procedure time was 60 minutes (range 15-310 minutes). There were 131 en bloc resections (94%), with curative resections achieved for 109 lesions (78%); 22 lesions (16%) resulted in non-curative resections, and 8 lesions (6%) had only a horizontal margin positive or had inconclusive results. A total of 118 patients (92%) were assessed as H pylori gastritis-positive, with 7 patients (5%) negative. Adverse events included 2 cases of delayed bleeding (1.4%) and 2 perforations (1.4%), with 1 patient requiring emergency surgery. The 5-year overall and cause-specific survival rates were 87.3% and 100%, respectively, during a median follow-up period of 4.5 years (range 0-13.7 years), with no deaths from

  19. Endoscopic Submucosal Dissection for Gastric Epithelial Tumors: A Multicenter Study in Taiwan

    Directory of Open Access Journals (Sweden)

    Chun-Chao Chang

    2009-01-01

    Conclusion: ESD is a promising local curative treatment option for EGC in Taiwan but it still carries risks of perforation and bleeding. The education and learning curve of endoscopists will improve the outcome of this procedure.

  20. Conducta alimentaria y perfil glucémico en dos líneas de ratas con diabetes genética: eSS y eSMT.

    OpenAIRE

    Silvana Marisa Montenegro; María Cristina Tarrés; Juan Carlos Picena; Stella Maris Martínez

    2005-01-01

    Introducción. La alimentación puede agravar la diabetes de humanos y modelos animales. Entre ellos, la rata eSMT presenta un curso más exacerbado y mayor biomasa que la línea parental eSS. Objetivo. Estudiar la conducta alimentaria de ratas macho eSMT y eSS ante oferta ilimitada y bajo restricción alternada, analizando su incidencia sobre el peso y la glucemia. Materiales y métodos. Se registró el consumo ad libitum en etapas de crecimiento y mantenimiento. Un grupo de eSMT recibió durante 5 ...

  1. Gastric Schwannoma: A Benign Tumor Often Misdiagnosed as Gastrointestinal Stromal Tumor.

    Science.gov (United States)

    Shah, Apurva S; Rathi, Pravin M; Somani, Vaibhav S; Mulani, Astha M

    2015-09-28

    Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma.

  2. Gastric schwannoma: a benign tumor often misdiagnosed as gastrointestinal stromal tumor

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    Apurva S. Shah

    2015-10-01

    Full Text Available Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma.

  3. Neurochemical features of endomorphin-2-containing neurons in the submucosal plexus of the rat colon.

    Science.gov (United States)

    Li, Jun-Ping; Zhang, Ting; Gao, Chang-Jun; Kou, Zhen-Zhen; Jiao, Xu-Wen; Zhang, Lian-Xiang; Wu, Zhen-Yu; He, Zhong-Yi; Li, Yun-Qing

    2015-09-14

    To investigate the distribution and neurochemical phenotype of endomorphin-2 (EM-2)-containing neurons in the submucosal plexus of the rat colon. The mid-colons between the right and left flexures were removed from rats, and transferred into Kreb's solution. For whole-mount preparations, the mucosal, outer longitudinal muscle and inner circular muscle layers of the tissues were separated from the submucosal layer attached to the submucosal plexus. The whole-mount preparations from each rat mid-colon were mounted onto seven gelatin-coated glass slides, and processed for immunofluorescence histochemical double-staining of EM-2 with calcitonin gene-related peptide (CGRP), choline acetyltransferase (ChAT), nitric oxide synthetase (NOS), neuron-specific enolase (NSE), substance P (SP) and vasoactive intestinal peptide (VIP). After staining, all the fluorescence-labeled sections were observed with a confocal laser scanning microscope. To estimate the extent of the co-localization of EM-2 with CGRP, ChAT, NOS, NSE, SP and VIP, ganglia, which have a clear boundary and neuronal cell outline, were randomly selected from each specimen for this analysis. In the submucosal plexus of the mid-colon, many EM-2-immunoreactive (IR) and NSE-IR neuronal cell bodies were found in the submucosal plexus of the rat mid-colon. Approximately 6 ± 4.2 EM-2-IR neurons aggregated within each ganglion and a few EM-2-IR neurons were also found outside the ganglia. The EM-2-IR neurons were also immunopositive for ChAT, SP, VIP or NOS. EM-2-IR nerve fibers coursed near ChAT-IR neurons, and some of these fibers were even distributed around ChAT-IR neuronal cell bodies. Some EM-2-IR neuronal cell bodies were surrounded by SP-IR nerve fibers, but many long processes connecting adjacent ganglia were negative for EM-2 immunostaining. Long VIP-IR processes with many branches coursed through the ganglia and surrounded the EM-2-IR neurons. The percentages of the EM-2-IR neurons that were also positive for

  4. Submucosal chromoendoscopy: a technique that highlights epithelia and differentiates histological components, and renders colon polypectomy easier and safer

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    Carlos Dolz-Abadía

    2015-07-01

    Full Text Available Submucosal chromoendoscopy involves the injection of a solution containing a vital stain, usually indigo carmine, into the intestinal wall submucosal layer. This allows to: Better delimit and characterize the various epithelia present (colonic mucosa, adenoma, hyperplastic polyp, serrated polyp, small bowel mucosa; expose and delimit lesion implantation areas; cooperate in the lifting of resectable lesions; ensure section across the submucosal plane; identify intestinal wall structures; render complex polypectomy feasible; and facilitate the identification of perforations. The present paper offers information on the endoscopic technique for submucosal injection, solution preparation and concentration, and on the potential benefits it may provide for polypectomy or endocopic mucosal resection whether en block or piecemeal. This endoscopic technique simultaneously combines a diagnostic and a therapeutic aspect, since lesion lifting in association with better delimited contours may improve not only accuracy but also endoscopic resection safety and feasibility.

  5. The importance of the apposition of the submucosal intestinal layers for primary wound healing of intestinal anastomosis.

    Science.gov (United States)

    Jansen, A; Becker, A E; Brummelkamp, W H; Keeman, J N; Klopper, P J

    1981-01-01

    This study was undertaken to examine the importance of the apposition of the submucosal layers in healing of the intestinal anastomosis. On 18 mongrel dogs, weighing between 8 and 15 kilograms, four anastomoses were performed on the small intestine. Two with a conventional anastomosis and two with rings of polyester-polyethyleneterephtalate, containing small Ticonal magnets. The force between the rings with the magnets varied from 0-3 newton between, respectively, 15 millimeters and zero millimeter distance. After three to four days, the rings cut through and disappeared from the anastomosis. Morphologic and microangiographic studies, undertaken at ten days, revealed that, in instances of good submucosal apposition, direct bridging of the defect in the submucosal layer was seen with rapid restoration of the villous epithelium and an undisturbed vascular pattern in the anastomotic area. This we called primary intestinal healing. In instances of bad submucosal apposition, we saw indirect bridging of the submucosal layer defect by smaller and longer strands of newly synthesized collagen tissue in the outer intestinal layers with a collateral circulation from the submucosal plexus to the arterial plexuses in these layers. In all instances, an epithelial defect still persisted at ten days. This type of wound healing we called secondary intestinal healing. The results showed that, with the magnetic rings, a significantly better apposition of the intestinal layers was achieved.

  6. Colonic Angiodysplasia with a Huge Submucosal Hematoma in the Sigmoid Colon

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    Takayuki Shimizu

    2016-01-01

    Full Text Available Colonic angiodysplasia (AD with bleeding as a comorbidity in the aging population is being increasingly reported. However, to our knowledge, there is no report on colonic AD accompanied by a huge hematoma. Herein, we report a case of colonic AD with a huge submucosal hematoma. A 75-year-old man with sudden melena was referred to our hospital. Helical computed tomographic angiography (CTA revealed bleeding from the sigmoid colon. Additionally, colonoscopy showed a huge submucosal hematoma with bleeding in the sigmoid colon. As endoscopic hemostasis was difficult, sigmoidectomy was performed. The pathological diagnosis was colonic AD. The present case indicates that colonic AD should be considered in the differential diagnosis for melena. In addition, the case shows that helical CTA, which is a noninvasive imaging modality, is useful for the diagnosis of colonic AD and is as effective as colonoscopy and angiography for diagnosis.

  7. Submucosal resection of a microcystic oropharyngeal lymphatic malformation using radiofrequency ablation.

    Science.gov (United States)

    Thottam, Prasad John; Al-Barazi, Randa; Madgy, David N; Rozzelle, Arlene

    2013-09-01

    Lymphatic malformations (LMs) are uncommon congenital anomalies noted to have a prevalence of 1 per 5000 births and comprise roughly 6% of all pediatric soft tissue lesions. Recently radiofrequency ablation has been described as a surgical option for the treatment microcystic LMs in the oral cavity, more specifically the tongue. The following case describes the use of radiofrequency ablation for the submucosal removal of a large obstructing pharyngeal LM in a 4-year-old female. The mucosal sparing approach and surgical method of extirpation are discussed in detail. To the authors' knowledge this is the first description of a submucosal coblation technique being used as treatment for pharyngeal LMs. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study

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    Ken Ohata

    2016-01-01

    Full Text Available Esophageal endoscopic submucosal dissection (ESD is technically difficult. To make it safer, we developed a novel method using overtube with a traction forceps (OTF for countertraction during submucosal dissection. We conducted an ex vivo animal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD. A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists. After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection. All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner’s C-ESD procedure. The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists (22.8±8.3 min versus 7.8±4.5 min, P<0.001, and 11.3±4.4 min versus 5.9±2.5 min, P=0.01, resp.. The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD (1.3±0.6 times versus 2.9±1.5 times, P<0.001, and 5.3±2.8 mL versus 15.6±7.3 mL, P<0.001, resp.. Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%, P=0.009. Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.

  9. Lubiprostone stimulates secretion from tracheal submucosal glands of sheep, pigs, and humans

    OpenAIRE

    Joo, N. S.; Wine, J. J.; Cuthbert, A. W.

    2009-01-01

    Lubiprostone, a putative ClC-2 chloride channel opener, has been investigated for its effects on airway epithelia (tracheas). Lubiprostone is shown to increase submucosal gland secretion in pigs, sheep, and humans and to increase short-circuit current (SCC) in the surface epithelium of pigs and sheep. Use of appropriate blocking agents and ion-substitution experiments shows anion secretion is the driving force for fluid formation in both glands and surface epithelium. From SCC concentration-r...

  10. Isolated submucosal lipomatosis of appendix mimicking acute appendicitis: computed tomography findings

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    Şükrü Şanlı

    2014-03-01

    Full Text Available Acute appendicitis is one of the more common surgical emergencies, and it is one of the most common causes of acute abdominal pain. Intestinal lipomatosis is a rare condition particularly the isolated form of lipomatosis of the appendix which may mimic or present as an acute appendicitis, that frequently requires the surgical exploration.In this paper, we report computed tomography findings of a case wıth isolated form of submucosal lipomatosis of appendix.

  11. NDE Conference on Civil Engineering : a joint conference of the 7th Structural Materials Technology Conference (SMT) and the 6th International Symposium on Nondestructive Testing in Civil Engineering (NDT-CE)

    Science.gov (United States)

    2007-01-01

    The 2006 NDE conference on Civil Engineering was held in St. Louis, MO on August 14 18, 2006. The conference combined the 7th Structural Materials Technology Conference (SMT) along with the 6th International Symposium on Nondestructive Testing in...

  12. Possibility of ex vivo animal training model for colorectal endoscopic submucosal dissection.

    Science.gov (United States)

    Yoshida, Naohisa; Yagi, Nobuaki; Inada, Yutaka; Kugai, Munehiro; Kamada, Kazuhiro; Katada, Kazuhiro; Uchiyama, Kazuhiko; Ishikawa, Takeshi; Takagi, Tomohisa; Handa, Osamu; Konishi, Hideyuki; Kokura, Satoshi; Inoue, Ken; Wakabayashi, Naoki; Abe, Yasuhisa; Yanagisawa, Akio; Naito, Yuji

    2013-01-01

    Colorectal endoscopic submucosal dissection (ESD) has not been standardized due to technical difficulties and requires extensive training for reliability. Ex vivo animal model is convenient, but has no blood flow. The objective of this study is to evaluate the characteristics of various ex vivo animal models including a blood flow model for colorectal ESD training and the usefulness of practicing endoscopic hemostasis and closure using an animal model. Harvested porcine cecum, rectum, and stomach and bovine cecum and rectum were analyzed regarding ease of mucosal injection, degree of submucosal elevation, and status of the proper muscle layer. Ex vivo animal model with blood flow was made using the bovine cecum. The vessel around the cecum was detached, and red ink was injected. Endoscopic hemostasis for perioperative hemorrhage and endoscopic closure for perforation were performed in this model. Mucosal injection was easily performed in the bovine cecum and rectum. Submucosal elevation was low in the bovine cecum, while the proper muscle layer was not tight in the porcine rectum and bovine cecum. Endoscopic hemostasis were accomplished in six (60 %) out of ten procedures of the ex vivo blood flow model. In two non-experts, the completion rates of endoscopic closure were 40 and 60 % in the first five procedures. These rates became 100 % in the last five procedures. We have evaluated the characteristics of various ex vivo animal models and shown the possibility of training for endoscopic hemostasis and endoscopic closure in the ex vivo animal model.

  13. [Treatment of recurrent laryngeal papilloma by submucosal resection and the effect on prognosis].

    Science.gov (United States)

    Hu, Huiying; Zhang, Qingxiang; Sun, Guoyan; Yu, Zhenkun

    2015-11-01

    To investigate the efficacy of submucosal resection by CO2 laser in the treatment of recurrent laryngeal papilloma and the effect on prognosis. A total of 11 patients diagnosed as recurrent laryngeal papilloma were included in this review. Papilloma was marked before operation and checked under fibro-laryngoscope. Papilloma was resected completely including the submucosal tissure with CO2 laser or microequipment. In widespread papilloma, false membrane in raw surface were cleared 7-10 days after operation. Surgical specimens (including membrane) were detected by routine pathology, HPV typing and immunohistochemical pathologic examination. The patients were checked once a month in the first 3 months after operation, and then once for every 3 months. Once the hoarseness and other symptoms aggravated or the disease was recurrent, the patients were treated immediately. HPV viral DNA was found in 10/11 cases, with HPV11 (7/11 cases) and HPV6 (3/11 cases). Cases with regards to follow-up, from 6 months to 1 year, 3 cases were followed up 1 year after operation, without recurrence. Five patients including 2 children were followed up 6 to 12 months after operation, without recurrence. Two children underwent 2 or 3 operations, were followed-up more than 6 months withouting recurrence. Papilloma submucosal resection could decrease postoperative recurrence and is worth to be further investigated.

  14. Down-regulation of SMT3A gene expression in association with DNA synthesis induction after X-ray irradiation in nevoid basal cell carcinoma syndrome (NBCCS) cells

    Energy Technology Data Exchange (ETDEWEB)

    Sugaya, Shigeru [Department of Environmental Biochemistry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670 (Japan); Nakanishi, Hiroshi [Department of Clinical Molecular Biology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670 (Japan); Tanzawa, Hideki [Department of Clinical Molecular Biology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670 (Japan); Sugita, Katsuo [Department of Clinical Medicine, Faculty of Education, Chiba University, 1-33 Yayoi, Inage-ku, Chiba 263-8522 (Japan); Kita, Kazuko [Department of Environmental Biochemistry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670 (Japan); Suzuki, Nobuo [Department of Environmental Biochemistry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670 (Japan)]. E-mail: nobuo@faculty.chiba-u.jp

    2005-10-15

    Fibroblast cells derived from nevoid basal carcinoma syndrome (NBCCS) patients show increased levels of DNA synthesis after X-ray irradiation. Genes, whose expression is modulated in association with the DNA synthesis induction, were searched by using PCR-based mRNA differential display analysis in one of the NBCCS cell lines, NBCCS1 cells. Decreased levels of SMT3A gene expression were found in X-ray-irradiated NBCCS1 cells. This decrease was also shown by RT-PCR analysis in another cell line, NBCCS3 cells. In addition to NBCCS cells, normal fibroblast cells showed the DNA synthesis induction after X-ray irradiation when they were treated with antisense oligonucleotides (AO) for SMT3A. However, treatment of normal fibroblasts with the random oligonucleotides (RO) resulted in decreased levels of DNA synthesis after X-ray irradiation. Thus, down-regulation of SMT3A gene expression may be involved in the DNA synthesis induction after X-ray irradiation in the NBCCS cells at least tested.

  15. A Novel Fixation Method for Variable-Sized Endoscopic Submucosal Dissection Specimens: An In Vitro Animal Experiment.

    Directory of Open Access Journals (Sweden)

    Seung Han Kim

    Full Text Available Endoscopic submucosal dissection is considered a curative and minimally invasive treatment for early gastric cancer; however, precise pathologic assessment of resected specimens is required to develop further treatment plans. Human error during specimen handling can affect objective assessment of resected specimens. In this study, we investigated whether a novel tissue fixation device offered more objective and standardized pathologic evaluation than conventional manual tissue fixation.We developed a novel tissue fixation device for endoscopic submucosal dissection specimens. Two circular tissue samples 2, 3, and 4 cm in diameter were obtained from the body of 45 porcine stomachs. One specimen sample was placed in a fixation device; the other was manually fixed on corkboard. We used a pressure indicator to ensure constant pressure in the resected specimens in the fixation device. We measured submucosal diameter and thickness after 24 hr.The diameters for 2, 3, and 4 cm resected tissue samples were 23.85, 32.30, and 45.0 mm and 21.0, 32.0, and 44.50 mm for the fixation device and manual pinning groups, respectively. The submucosal thicknesses in the fixation device group were 397.09, 381.43, and 415.51 μm and 393.76, 529.69, and 603.82 μm by manual pinning for 2, 3, and 4 cm tissue samples, respectively. Analysis of standard deviation revealed that the submucosal thickness in the manual fixation group was much more variable than in the fixation device group (p = 0.012, 0.042, and 0.001 for 2, 3, and 4 cm tissue specimens, respectively; Fligner-Killeen test of homogeneity of variances.Among variously sized resected tissue specimens, submucosal thicknesses were more variable in the conventional fixation group, while the thicknesses were comparatively consistent in the fixation device group. After endoscopic submucosal dissection, pathologic preparation using this fixation device could offer more objective assessment of specimens.

  16. Smooth Muscle Tumor Originating in the Pleura: A Case Report and Updated Literature Review

    Directory of Open Access Journals (Sweden)

    Santiago Fabián Moscoso Martínez

    2016-01-01

    Full Text Available Smooth muscle tumors (SMTs of the pleura are exceptionally rare. At present and to the best of these authors’ knowledge, there are only 17 cases reported in the literature. We describe a case of a 51-year-old woman who complained of left sided pleuritic chest pain. Further, computed tomography (CT revealed a left sided localized pleural-based mass involving the 9th rib. She underwent an interventional radiology guided percutaneous core biopsy of the lesion, which disclosed a “Smooth Muscle Tumor of Undetermined Malignant Potential (SMT-UMP.” A video-assisted thoracoscopic surgery (VATS was performed for diagnosis and treatment purposes. Resections of the pleural-based mass and 9th rib were performed. SMT-UMP was the definitive diagnosis.

  17. Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls

    Directory of Open Access Journals (Sweden)

    Charalampos G. Markakis

    2013-01-01

    Full Text Available Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. This is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. The pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. The patient has shown no evidence of recurrence one year postoperatively. Conclusions. This report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs.

  18. Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis.

    Science.gov (United States)

    Bayer, Julia; Vackova, Zuzana; Svecova, Hana; Stirand, Petr; Spicak, Julius; Martinek, Jan

    2017-06-27

    Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. According to the original Inoue's technique, a submucosal lavage with gentamicin has been practiced due to the fear of infection. This single-tertiary center study was intended to assess the clinical significance of the topical antibiotic lavage during POEM. A retrospective analysis of prospectively collected data was conducted. The outcomes of patients who received the gentamicin lavage (group A) during POEM were compared to those who did not (group B). The main outcome variables were infectious adverse events, post-POEM fever, and markers of systemic inflammatory response. One day before and after POEM, all patients received systemic antibiotic prophylaxis with ceftriaxone. Of 124 consecutive patients having undergone POEM, 60 patients received a lavage with 80 mg of gentamicin into the submucosal tunnel before starting the myotomy, while 64 patients did not. The overall treatment success at 3 months did not differ between the two groups (group A 94.7 vs. 97.5% group B). We did not experience any significant infectious adverse events in either group. CRP and WBC levels were lower in patients with lavage versus those without [CRP: median 52.7 (IQR 34.9) vs. 69.5 (54.1); p = 0.01; WBCs: median 10.9 (IQR 3.3) vs. 12.6 (3.9); p POEM, the submucosal lavage with gentamicin prior to the myotomy does not play a role in the prevention of clinically significant infectious adverse events, although the systemic inflammatory response may be decreased.

  19. Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer.

    Science.gov (United States)

    Myung, Yu Sik; Hong, Su Jin; Han, Jae Pil; Park, Kyung Woo; Ko, Bong Min; Lee, Moon Sung

    2017-01-01

    In ulcerative early gastric cancer, improvement and exacerbation of ulceration repeat as a malignant cycle. Moreover, early gastric cancer combined with ulcer is associated with a low curative resection rate and high risk of adverse events. The aim of this study was to investigate the ulcer healing rate and clinical outcomes with the administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer. A total of 136 patients with differentiated early gastric cancer with ulcer who met the expanded indications for endoscopic submucosal dissection were reviewed between June 2005 and June 2014. Eighty-one patients were given PPI before endoscopic submucosal dissection and 55 patients were not given PPI. The complete ulcer healing rate was significantly different between the two groups (59.3 % vs. 23.6 %, P cancer.

  20. Report on an Assessment of the Application of EPP Results from the Strain Limit Evaluation Procedure to the Prediction of Cyclic Life Based on the SMT Methodology

    Energy Technology Data Exchange (ETDEWEB)

    Jetter, R. I. [R. I. Jetter Consulting, Pebble Beach, CA (United States); Messner, M. C. [Argonne National Lab. (ANL), Argonne, IL (United States); Sham, T. -L. [Argonne National Lab. (ANL), Argonne, IL (United States); Wang, Y. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2017-08-01

    The goal of the proposed integrated Elastic Perfectly-Plastic (EPP) and Simplified Model Test (SMT) methodology is to incorporate an SMT data based approach for creep-fatigue damage evaluation into the EPP methodology to avoid the separate evaluation of creep and fatigue damage and eliminate the requirement for stress classification in current methods; thus greatly simplifying evaluation of elevated temperature cyclic service. This methodology should minimize over-conservatism while properly accounting for localized defects and stress risers. To support the implementation of the proposed methodology and to verify the applicability of the code rules, analytical studies and evaluation of thermomechanical test results continued in FY17. This report presents the results of those studies. An EPP strain limits methodology assessment was based on recent two-bar thermal ratcheting test results on 316H stainless steel in the temperature range of 405 to 7050C. Strain range predictions from the EPP evaluation of the two-bar tests were also evaluated and compared with the experimental results. The role of sustained primary loading on cyclic life was assessed using the results of pressurized SMT data from tests on Alloy 617 at 9500C. A viscoplastic material model was used in an analytic simulation of two-bar tests to compare with EPP strain limits assessments using isochronous stress strain curves that are consistent with the viscoplastic material model. A finite element model of a prior 304H stainless steel Oak Ridge National Laboratory (ORNL) nozzle-to-sphere test was developed and used for an EPP strain limits and creep-fatigue code case damage evaluations. A theoretical treatment of a recurring issue with convergence criteria for plastic shakedown illustrated the role of computer machine precision in EPP calculations.

  1. An Electrosurgical Endoknife with a Water-Jet Function (Flushknife Proves Its Merits in Colorectal Endoscopic Submucosal Dissection Especially for the Cases Which Should Be Removed En Bloc

    Directory of Open Access Journals (Sweden)

    Yoji Takeuchi

    2013-01-01

    Full Text Available Background. Previously, we reported that the Flushknife (electrosurgical endoknife with a water-jet function could reduce the operation time of colorectal endoscopic submucosal dissection (ESD however, suitable situation for the Flushknife was obscure. This subgroup analysis of a prospective randomized controlled trial was aimed to investigate the suitable situation for the Flushknife. Methods. A total of 48 superficial colorectal neoplasms that underwent ESD using either the Flexknife or the Flushknife in a referral center were enrolled. The differences of operation time between the Flexknife and the Flushknife groups in each subgroup (tumor size, location, and macroscopic type were analyzed. Results. Median (95% CI operation time calculated using survival curves was significantly shorter in the Flushknife group than in the Flexknife group (55.5 min [41, 78] versus 74.0 [57, 90] min; , Hazard Ratio HR: 0.53; 95% CI (0.29–0.97. In particular, the HR in patients with laterally spreading tumors-nongranular type (LST-NG in the Flushknife group was significantly smaller than in the Flexknife group (HR: 0.1650.17; 95% CI (0.04–0.66. There was a trend of decreasing HRs according to larger lesion size. Conclusions. The Flushknife proved its merits in colorectal ESD especially for the lesions which should be removed en bloc (LST-NG and large lesion.

  2. MNiBLoS: A SMT-based Solver for Continuous t-norm Based Logics and Some of their Modal Expansions

    Czech Academy of Sciences Publication Activity Database

    Vidal, Amanda

    2016-01-01

    Roč. 372, 1 December (2016), s. 709-730 ISSN 0020-0255 R&D Projects: GA ČR(CZ) GF15-34650L Grant - others:Austrian Science Fund(AT) I1897-N25; EdeTRI:TIN2012-39348-C02-01(ES) MINECO project; CSIC Intramural Project(ES) 201450E045 Institutional support: RVO:67985807 Keywords : fuzzy logic s * modal logic s * automated reasoning * continuous t-norms * SMT * infinitely valued logic s Subject RIV: BA - General Mathematics Impact factor: 4.832, year: 2016

  3. Muco-submucosal elongated polyps of the gastrointestinal tract: a case series and a review of the literature.

    Science.gov (United States)

    Tan, Char Loo; Tan, Sze Hwa; So, Jimmy B Y; Petersson, Fredrik

    2013-03-21

    We present three cases of gastrointestinal muco-submucosal elongated polyps, two located in the duodenum and one in the descending colon. All three cases had a characteristic, "worm-like" endoscopic appearance and were lined by unremarkable mucosa. The vascular component was located in the submucosa and was composed of a mixture of variably dilated blood vessels (capillaries and veins) and lymphatics. The duodenal polyps displayed lipomatous metaplasia of the submucosal stroma. The dual vascular phenotype of the vascular component was confirmed by immunohistochemistry with D2-40 and CD31.

  4. Perivascular Epithelioid Cell Tumor in the Stomach

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    Sun Ah Shin

    2017-07-01

    Full Text Available Perivascular epithelioid cell tumors or PEComas can arise in any location in the body. However, a limited number of cases of gastric PEComa have been reported. We present two cases of gastric PEComas. The first case involved a 62-year-old woman who presented with a 4.2 cm gastric subepithelial mass in the prepyloric antrum, and the second case involved a 67-year-old man with a 5.0 cm mass slightly below the gastroesophageal junction. Microscopic examination revealed that both tumors were composed of perivascular epithelioid cells that were immunoreactive for melanocytic and smooth muscle markers. Prior to surgery, the clinical impression of both tumors was gastrointestinal stromal tumor (GIST, and the second case was erroneously diagnosed as GIST even after microscopic examination. Although gastric PEComa is a very rare neoplasm, it should be considered in the differential diagnosis of gastric submucosal lesions.

  5. Same site submucosal tunneling for a repeat per oral endoscopic myotomy: A safe and feasible option.

    Science.gov (United States)

    Wehbeh, Antonios N; Mekaroonkamol, Parit; Cai, Qiang

    2016-10-16

    Per oral endoscopic myotomy (POEM) is a novel endoscopic procedure for achalasia treatment. Due to its novelty and high success rates, a repeat procedure is usually not warranted, making the feasibility and safety of such approach unknown. We report the first case of a successful repeat POEM done at the same site of a previously uncompleted POEM. An 84-year-old female with type 2 achalasia presented for a POEM procedure. The procedure was aborted at the end of tunneling and before myotomy due to hypotension, which later resolved spontaneously. POEM was re-attempted at the same site of the original tunnel 1 year afterward, and surprisingly we didn't encounter any submucosal fibrosis. The procedure felt similar to a native POEM and a myotomy was performed uneventfully. Our case is the first to suggest that submucosal tunneling during a repeat POEM can be done at the same site. Hypotension during POEM is a rare complication that should be recognized as a potential result of tension capnothorax, it can however, be managed with close supportive care.

  6. Esophageal endoscopic submucosal dissection using sodium hyaluronate is safe and effective.

    Science.gov (United States)

    Iwashita, Chihiro; Sakamoto, Hirotsugu; Miura, Yoshimasa; Shinozaki, Satoshi; Hayashi, Yoshikazu; Ino, Yuji; Osawa, Hiroyuki; Tamba, Mio; Morita, Kohei; Lefor, Alan Kawarai; Yamamoto, Hironori

    2017-07-27

    A submucosal cushion of sodium hyaluronate facilitates gastric and colorectal endoscopic submucosal dissection (ESD). However, few studies have evaluated the utility of sodium hyaluronate for ESD of esophageal lesions. The aim of this study is to evaluate the utility and safety of sodium hyaluronate for ESD of superficial esophageal squamous cell neoplasms (ESCN). We retrospectively reviewed 111 ESCN in 86 patients treated by ESD between September 2007 and April 2013. There were four double cancers, with 107 ESD procedures analyzed. The en bloc resection rate was 99% (106/107). The R0 resection rate was 93% (99/107). Of 106 specimens resected en bloc, four specimens had a positive horizontal margin, two specimens had non-assessable horizontal margins and one specimen had non-assessable horizontal and vertical margins. One patient with a non-assessable horizontal margin developed local recurrence seven months later, treated by repeat ESD. Delayed bleeding occurred in two procedures (2%), and intra-procedural perforation occurred in four (4%). None required operative repair. Endoscopy trainees performed 33 of 107 (31%) ESD procedures. Post-ESD stenosis requiring dilation occurred following five procedures (5%). Sodium hyaluronate for ESD of ESCN achieves a high R0 resection rate with a low rate of adverse events.

  7. Submucosal dexamethasone injection improves quality of life measures after third molar surgery: a comparative study.

    Science.gov (United States)

    Majid, Omer Waleed

    2011-09-01

    The purpose of the present study was to compare the effect of submucosal versus intramuscular administration of dexamethasone sodium phosphate on patients' quality of life after surgical removal of impacted lower third molars. A randomized, non-blind, clinical trial was planned. The sample was composed of patients requiring extraction under local anesthesia of a single partial bony impacted mandibular third molar with Class II or III and position B or C, according to the Pell and Gregory classification. The patients were randomly distributed into 1 of 3 groups: submucosal dexamethasone, intramuscular dexamethasone, and a control group that received no steroid. A modified translated questionnaire was used to assess the patients' perception regarding different quality of life dimensions. In addition, the objective measurements of facial pain, swelling, and trismus were performed on days 1, 3, and 7 postoperatively. A total of 33 subjects requiring surgical removal of a single impacted mandibular third molar under local anesthesia were included in the present study. Both dexamethasone groups showed a significant reduction in swelling and pain compared with the control group at all intervals (P third molars with a comparable effect on postoperative sequelae to intramuscular injection. It offers a simple, safe, painless, noninvasive, and cost effective therapeutic option for moderate and severe cases. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Submucosal connective tissue-type mast cells contribute to the production of lysophosphatidic acid (LPA) in the gastrointestinal tract through the secretion of autotaxin (ATX)/lysophospholipase D (lysoPLD).

    Science.gov (United States)

    Mori, Ken; Kitayama, Joji; Aoki, Junken; Kishi, Yasuhiro; Shida, Dai; Yamashita, Hiroharu; Arai, Hiroyuki; Nagawa, Hirokazu

    2007-07-01

    Lysophosphatidic acid (LPA) is involved in a broad spectrum of biological activities, including wound healing and cancer metastasis. Autotaxin (ATX), originally isolated from a melanoma supernatant as a tumor cell motility-stimulating factor, has been shown to be molecularly identical to lysophospholipase D (lysoPLD), which is the main enzyme in the production of LPA. Although ATX/lysoPLD is known to be widely expressed in normal human tissues, the exact distribution of ATX-producing cells has not been fully investigated. In this study, we evaluated ATX/lysoPLD expression by immunohistochemical staining using a rat anti-ATX mAb in the human gastrointestinal tract and found that submucosal mast cells (MC) highly expressed this enzyme. This was confirmed by immunofluorescent double staining using mAbs to tryptase and chymase. Then, we isolated MC from human gastric tissue by an immunomagnetic method using CD117-microbeads and showed that a subpopulation of CD203c-positive MC showed positive staining for intracellular ATX/lysoPLD on flowcytometry. This was confirmed by Western blotting of the isolated cells. Moreover, a significant level of ATX/lysoPLD release could be detected in the culture supernatants of human MC by Western blot analysis. Our data suggest that submucosal MC play significant roles in various aspects of pathophysiology in the gastrointestinal tract by locally providing bioactive LPA through the production of ATX/lysoPLD.

  9. Comparative study on Virtual Reality Training (VRT over Sensory Motor Training (SMT in Unilateral Chronic Osteoarthritis – A Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Fathy Abdelazim Awwad Elshazly

    2016-08-01

    Full Text Available Osteoarthritis is a common rheumatologic disease. Several non operative interventions have been described for the treatment. But the available evidences of comparing the effectiveness of Virtual reality training over sensory motor training are very few. So, the purpose of this study is to compare the effectiveness of Virtual reality training over sensory motor training in the treatment of Osteoarthritis. 60 subjects who fulfilled the inclusion and exclusion criteria were divided into three Groups (1, 2 & 3 with randomized sampling method. Group 1 treated with Virtual reality training (VRT, Group 2 treated with sensory motor training (SMT and Group 3 (control treated with conventional exercise training (CET. The duration of the treatment was three times per week for 8 weeks in all the three groups. Subjects were assessed at baseline, at 4th and 8th week. Pain Intensity by Visual Analog scale (VAS, Joint Proprioception by Perception Sense, Functional Disability by WOMAC Score, and Quality of Life by HRQOL score were measured. A statistically significant (p ≤ 0.05 difference between all the 3 groups were noted at the period of 8 week for pain intensity, joint proprioception, functional disability and quality of life. Group-1 treated with (VRT shows more significant improvement in all parameters compared with Group-2 (SMT and Group-3 (CET. In conclusion, the addition of virtual reality training to conventional training exercises could improve pain and proprioception which subsequently improve the functional level and quality of life of OA patients

  10. Comparative in vitro activities of SMT19969, a new antimicrobial agent, against Clostridium difficile and 350 gram-positive and gram-negative aerobic and anaerobic intestinal flora isolates.

    Science.gov (United States)

    Goldstein, Ellie J C; Citron, Diane M; Tyrrell, Kerin L; Merriam, C Vreni

    2013-10-01

    The comparative in vitro activity of SMT19969, a novel, narrow-spectrum, nonabsorbable agent, was studied against 50 ribotype-defined Clostridium difficile strains, 174 Gram-positive and 136 Gram-negative intestinal anaerobes, and 40 Gram-positive aerobes. SMT19969 was one dilution more active against C. difficile isolates (MIC range, 0.125 to 0.5 μg/ml; MIC90, 0.25 μg/ml), including ribotype 027 strains, than fidaxomicin (range, 0.06 to 1 μg/ml; MIC90, 0.5 μg/ml) and two to six dilutions lower than either vancomycin or metronidazole. SMT19969 and fidaxomicin were generally less active against Gram-negative anaerobes, especially the Bacteroides fragilis group species, than vancomycin and metronidazole, suggesting that SMT19969 has a lesser impact on the normal intestinal microbiota that maintain colonization resistance. SMT19969 showed limited activity against other Gram-positive anaerobes, including Bifidobacteria species, Eggerthella lenta, Finegoldia magna, and Peptostreptococcus anaerobius, with MIC90s of >512, >512, 64, and 64 μg/ml, respectively. Clostridium species showed various levels of susceptibility, with C. innocuum being susceptible (MIC90, 1 μg/ml) and C. ramosum and C. perfringens being nonsusceptible (MIC90, >512 μg/ml). Activity against Lactobacillus spp. (range, 0.06 to >512 μg/ml; MIC90, >512 μg/ml) was comparable to that of fidaxomicin and varied by species and strain. Gram-positive aerobic cocci (Staphylococcus aureus, Enterococcus faecalis, E. faecium, and streptococci) showed high SMT19969 MIC90 values (128 to >512 μg/ml).

  11. Poly(lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(lactic acid-co-glycolic acid) thermogel as a novel submucosal cushion for endoscopic submucosal dissection.

    Science.gov (United States)

    Yu, Lin; Xu, Wei; Shen, Wenjia; Cao, Luping; Liu, Yan; Li, Zhaoshen; Ding, Jiandong

    2014-03-01

    Endoscopic submucosal dissection (ESD) is a clinical therapy for early stage neoplastic lesions in the gastrointestinal tract. It is, however, faced with a crucial problem: the high occurrence of perforation. The formation of a submucosal fluid cushion (SFC) via a fluid injection is the best way to avoid perforation, and thus an appropriate biomaterial is vital for this minimally invasive endoscopic technique. In this study, we introduced an injectable thermogel as a novel submucosal injection substance in ESD. The hydrogel synthesized by us was composed of poly(lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) triblock copolymers. The polymer/water system was a low-viscosity fluid at room temperature and thus easily injected, and turned into a non-flowing gel at body temperature after injection. The submucosal injection of the thermogel to create SFCs was performed in both resected porcine stomachs and living minipigs. High mucosal elevation with a clear margin was maintained for a long duration. Accurate en bloc resection was achieved with the assistance of the thermogel. The mean procedure time was strikingly reduced. Meanwhile, no obvious bleeding, perforation and tissue damage were observed. The application of the thermogel not only facilitated the ESD procedure, but also increased the efficacy and safety of ESD. Therefore, the PLGA-PEG-PLGA thermogel provides an excellent submucosal injection system, and has great potential to improve the ESD technique significantly. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  12. Submucosal injection of dexamethasone and methylprednisolone for the control of postoperative sequelae after third molar surgery: randomized controlled trial.

    Science.gov (United States)

    Chugh, A; Singh, S; Mittal, Y; Chugh, V

    2018-02-01

    Pain, swelling, and trismus are known sequelae of third molar surgery that can significantly affect the individual's quality of life (QOL). These should be minimized to improve QOL. The purpose of this study was to compare the effects of the preoperative submucosal administration of equivalent doses of two commonly used steroids on these postoperative sequelae. A randomized controlled clinical trial was conducted involving 60 subjects requiring the removal of impacted mandibular third molars. Extraction cases with a similar difficulty index were included. The participants were allocated randomly to three groups: the placebo group received normal saline injection (control), while the 8mg dexamethasone group and 40mg methylprednisolone group received submucosal injections of these steroids preoperatively. Each participant was assessed for postoperative pain, swelling, and trismus, along with a subjective assessment of QOL through a structured questionnaire. The participants administered dexamethasone showed significant reductions in pain and trismus compared to the control group (P<0.05). Submucosal injection of dexamethasone was found to be superior to methylprednisolone only in terms of the reduction in swelling. QOL was minimally affected in patients administered dexamethasone as compared to methylprednisolone and control subjects. The preoperative submucosal use of steroids can be considered an effective, safe, and simple therapeutic strategy to reduce swelling, pain, and trismus after the surgical removal of impacted mandibular third molars. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos).

    Science.gov (United States)

    Gotoda, Takuji; Oda, Ichiro; Tamakawa, Katsunori; Ueda, Hirohisa; Kobayashi, Toshiaki; Kakizoe, Tadao

    2009-01-01

    The treatment of early gastric cancer (EGC) by endoscopic submucosal dissection (ESD) has been rapidly gaining popularity in Japan. However, the procedure needs a high quality of skill. To facilitate complicated ESD by using a single working-channel gastroscope ("one-hand surgery method"), the magnetic-anchor-guided ESD (MAG-ESD) controlled by an extracorporeal electromagnet was reported to be successful in a porcine model. The purpose of this prospective clinical trial was to evaluate the feasibility of MAG-ESD for large EGC located on the gastric body in human beings. Prospective clinical trial at a single center. National Cancer Center Hospital, Tokyo, Japan. From January 2005 to May 2006, 25 patients with EGC >20 mm in diameter, located in the gastric body, and intestinal-type histology were enrolled. Patients with a cardiac pacemaker, advanced malignancy in other organs, severe cardiac and/or pulmonary diseases, and uncontrolled hypertension and/or diabetes mellitus were excluded from this study. Similar to a standard ESD, the MAG-ESD procedure was performed with the patient under conscious sedation by intravenous injection of midazolam (3-5 mg) and pentazocine (15 mg). Unfavorable events and other intraoperative complications caused by the magnetic anchor or the magnetic force were recorded and evaluated. Two GI endoscopists (T.G., I.O.) assessed whether the magnetic anchor facilitated gastric ESD according to 2 criteria: "supportive" and "not supportive." The en bloc resection rate, complications, total operation time, bleeding, perforation, and recurrence rate were also evaluated. The total operation time was measured from insertion to withdrawal of the endoscope, including the retrieving of the magnetic anchor or anchors. All tumors were resected en bloc, without any perforations or severe uncontrollable bleeding. All magnetic anchors were safely retrieved. Two endoscopists assessed that the MAG system was supportive in 23 patients. None of the patients

  14. Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

    Science.gov (United States)

    Sekiguchi, Masau; Suzuki, Haruhisa; Oda, Ichiro; Yoshinaga, Shigetaka; Nonaka, Satoru; Saka, Makoto; Katai, Hitoshi; Taniguchi, Hirokazu; Kushima, Ryoji; Saito, Yutaka

    2012-01-01

    Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection (ESD). In terms of the treatment of such perforations, we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively. We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure. In December 2006, we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis. A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection. Intensive conservative management was conducted following ESD, however, an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy. PMID:22919258

  15. Substance P stimulates CFTR-dependent fluid secretion by mouse tracheal submucosal glands.

    Science.gov (United States)

    Ianowski, Juan P; Choi, Jae Young; Wine, Jeffrey J; Hanrahan, John W

    2008-11-01

    The mucosa of the proximal airways defends itself and the lower airways from inhaled irritants such as capsaicinoids, allergens, and infections by several mechanisms. Sensory nerves monitor the luminal microenvironment and release the tachykinin substance P (SP) to stimulate mucus secretion. Here, we have studied the role of the cystic fibrosis transmembrane conductance regulator (CFTR) in SP stimulation by comparing mouse airway submucosal gland responses in wild-type (WT) and CFTR-/- mice. Capsaicinoids (chili pepper oil) increased fluid secretion by glands from WT mice five-fold, and this response was abolished by exposing the basolateral aspect of the tracheas to L-732,138 (10 micromol/l), a specific antagonist of the neurokinin-1 receptor. Secretion was also stimulated 25-fold by basolateral application of SP, and this response was strongly inhibited by the CFTR inhibitor CFTR(inh)172. In contrast, submucosal glands from CFTR knockout mice failed to secrete when stimulated by SP (1 micromol/l), although those from wild-type control littermates were responsive. SP stimulation of wild-type glands was also abolished by clotrimazole (25 micromol/l), a blocker of Ca(2+)-activated K(+) channels. These results indicate that SP mediates local responses to capsaicinoids through a mechanism involving coordinated activation of CFTR and K(+) channels. To our knowledge, this is the first study in which CFTR-dependent responses to substance P have been directly demonstrated. Since CFTR regulation is qualitatively similar in human and mouse glands, loss of this local regulation in CF may contribute to reduced innate defenses in CF airways.

  16. Vonoprazan prevents bleeding from endoscopic submucosal dissection-induced gastric ulcers.

    Science.gov (United States)

    Kagawa, T; Iwamuro, M; Ishikawa, S; Ishida, M; Kuraoka, S; Sasaki, K; Sakakihara, I; Izumikawa, K; Yamamoto, K; Takahashi, S; Tanaka, S; Matsuura, M; Hasui, T; Wato, M; Inaba, T

    2016-09-01

    Vonoprazan, a potassium-competitive acid blocker, is expected to improve the healing of endoscopic submucosal dissection (ESD)-induced gastric ulcers compared with proton pump inhibitors (PPIs). To compare the healing status of ESD-induced gastric ulcers and the incidence of post-ESD bleeding between subjects treated with vonoprazan for 5 weeks and those treated with PPIs for 8 weeks. Patients in the vonoprazan group (n = 75) were prospectively enrolled, whereas patients in the PPI group (n = 150) were selected for a 2:1 matched historical control cohort according to baseline characteristics including gastric ulcer size immediately following ESD, age, sex and status of Helicobacter pylori infection. Two controls per case of vonoprazan-treated group were matched with a margin of 20% in terms of ulcer size and a margin of 5 years in terms of their age. Although a higher number of completely healed ulcers was observed in the PPI group (95/150, 63.3%) than that in the vonoprazan group (14/75, 18.7%; P size reduction rates, which were 96.0 ± 6.7% in the vonoprazan group and 94.7 ± 11.6% in the PPI group, were not significantly different (P = 0.373). The post-ESD bleeding incidence in the vonoprazan group (1/75, 1.3%) was less than that in the PPI group (15/150, 10.0%; P = 0.01). The factors affecting post-ESD bleeding incidence were the type of acid secretion inhibitor (P = 0.016) and use of an anti-thrombotic agent (P = 0.014). Vonoprazan significantly reduced post-endoscopic submucosal dissection bleeding compared with PPIs. © 2016 John Wiley & Sons Ltd.

  17. Lubiprostone stimulates secretion from tracheal submucosal glands of sheep, pigs, and humans.

    Science.gov (United States)

    Joo, N S; Wine, J J; Cuthbert, A W

    2009-05-01

    Lubiprostone, a putative ClC-2 chloride channel opener, has been investigated for its effects on airway epithelia (tracheas). Lubiprostone is shown to increase submucosal gland secretion in pigs, sheep, and humans and to increase short-circuit current (SCC) in the surface epithelium of pigs and sheep. Use of appropriate blocking agents and ion-substitution experiments shows anion secretion is the driving force for fluid formation in both glands and surface epithelium. From SCC concentration-response relations, it is shown that for apical lubiprostone K(d) = 10.5 nM with a Hill slope of 1.08, suggesting a single type of binding site and, from the speed of the response, close to the apical surface, confirmed the rapid blockade by Cd ions. Responses to lubiprostone were reversible and repeatable, responses being significantly larger with ventral compared with dorsal epithelium. Submucosal gland secretion rates following basolateral lubiprostone were, respectively, 0.2, 0.5, and 0.8 nl gl(-1) min(-1) in humans, sheep, and pigs. These rates dwarf any contribution surface secretion adds to the accumulation of surface liquid under the influence of lubiprostone. Lubiprostone stimulated gland secretion in two out of four human cystic fibrosis (CF) tissues and in two of three disease controls, chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis (COPD/IPF), but in neither type of tissue was the increase significant. Lubiprostone was able to increase gland secretion rates in normal human tissue in the continuing presence of a high forskolin concentration. Lubiprostone had no spasmogenic activity on trachealis muscle, making it a potential agent for increasing airway secretion that may have therapeutic utility.

  18. Clinical Effectiveness of Submucosal Injection with Indigo Carmine Mixed Solution for Colon Endoscopic Mucosal Resection.

    Science.gov (United States)

    Han, Su Jung; Jung, Yunho; Cho, Young Sin; Chung, Il-Kwun; Kim, Jae Yun; Eun, Jun Young; Lee, Seoung Ho; Ko, Gyu Bong; Lee, Tae Hoon; Park, Sang Hum; Cho, Hyun Deuk; Kim, Sun-Joo

    2018-01-30

    Submucosal injection with indigo carmine mixed solution can improve the delineation of colorectal neoplasia during endoscopic mucosal resection (EMR). Thus, the aim of this study was to evaluate the efficacy of submucosal injection with indigo carmine mixed solution during EMR of colorectal neoplasia. This was a prospective, randomized, controlled study of a total of 212 neoplastic colon polyps (5-20 mm) subjected to EMR in a single tertiary university hospital. The patients were randomized into two groups according to whether or not indigo carmine mixed solution was used, and the complete resection rate (CRR) after EMR was evaluated. A total of 212 neoplastic polyps (normal saline group, 115; indigo carmine group, 97) were successfully removed by EMR. There was no significant difference in the CRR (92.8 vs. 89.6%, p = 0.414) or macroscopic delineation (86.0 vs. 93.8%, p = 0.118) between the two groups. In a separate analysis of sessile serrated adenomas/polyps (SSAs/Ps), macroscopic delineation was better in the indigo carmine group than the normal saline group (87.5 vs. 53.8%), albeit not significantly (p = 0.103). In univariate analyses, the CRR was significantly related to polyp location, polyp morphology, macroscopic delineation, and pathologic findings. In a multiple logistic regression analysis, macroscopic delineation (odds ratio (OR), 7.616, p = 0.001) and polyp pathology (OR, 8.621; p indigo carmine mixed solution did not improve the CRR or macroscopic delineation of EMR of colorectal neoplasias.

  19. Useful condition of chromoendoscopy with indigo carmine and acetic acid for identifying a demarcation line prior to endoscopic submucosal dissection for early gastric cancer.

    Science.gov (United States)

    Numata, Norifumi; Oka, Shiro; Tanaka, Shinji; Yoshifuku, Yoshikazu; Miwata, Tomohiro; Sanomura, Yoji; Arihiro, Koji; Shimamoto, Fumio; Chayama, Kazuaki

    2016-07-19

    Identifying a precise demarcation line (DL) is indispensable for pathological complete en bloc endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We evaluated the useful condition of chromoendoscopy with indigo carmine and acetic acid for marking dots around lesions before ESD for EGC. We examined 98 consecutive patients with 109 intramucosal EGCs (mean diameter, 17.8 ± 12.4 mm; main histologic type, 96 intestinal and 13 diffuse) resected by en bloc ESD after chromoendoscopy with indigo carmine and acetic acid between December 2012 and February 2014. The DL was identified by this technique just before ESD (mean chromoendoscopy observation time, 71.6 s); subsequently, marking dots were placed around the EGC. EGCs were classified into two groups: useful for identifying the DL or useless. Clinicopathological characteristics and clinical outcomes were evaluated in each group. Forty-two of the 109 cases (38.5 %) were determined useful for chromoendoscopy with indigo carmine and acetic acid. Multivariate analysis with logistic regression showed that macroscopic type (protruded or flat elevated-type) and atrophic border (the oral side of tumor) were independently associated with the usefulness of chromoendoscopy using indigo carmine and acetic acid for identifying the DL of EGCs (P indigo carmine and acetic acid can be used for creating precise markings in protruded or flat elevated-type EGC or at the atrophic border on the oral side of EGCs.

  20. Pituitary Tumors

    Science.gov (United States)

    ... of Tumors Astrocytoma Atypical Teratoid Rhaboid Tumor (ATRT) Chondrosarcoma Choroid Plexus Craniopharyngioma Cysts Ependymoma Germ Cell Tumor ... of Tumors Astrocytoma Atypical Teratoid Rhaboid Tumor (ATRT) Chondrosarcoma Choroid Plexus Craniopharyngioma Cysts Ependymoma Germ Cell Tumor ...

  1. Successful Treatment of Early Gastric Cancer Adjacent to a Fundal Varix by Endoscopic Submucosal Dissection and Endoscopic Cyanoacrylate Therapy

    OpenAIRE

    Kim, Yeon Soo; Cho, Won Young; Cho, Joo Young; Jin, So Young

    2012-01-01

    Endoscopic submucosal dissection (ESD) was developed for the en bloc resection of large early gastrointestinal neoplasms. A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications. Endoscopic variceal obturation (EVO) using cyanoacrylate has emerged as the initial treatment of choice for acute gastric variceal bleeding. This procedure achieves hemostasis in 90% of cases. A 52-year-old patient with Child A alcoholic ...

  2. Water-jet dissector for endoscopic submucosal dissection in an animal study: outcomes of the continuous and pulsed modes.

    Science.gov (United States)

    Lepilliez, Vincent; Robles-Medranda, Carlos; Ciocirlan, Mihai; Lukashok, Hannah; Chemali, Marwan; Langonnet, Stephan; Chesnais, Sabrina; Hervieu, Valerie; Ponchon, Thierry

    2013-08-01

    Endoscopic submucosal dissection (ESD) allows en bloc resection of early neoplastic lesions of gastrointestinal tract. Lesions are lifted by submucosal fluid injection before circumferential incision and dissection. High-pressure fluid injection using water jet (WJ) technology is already used for lifting and dissection in surgery. The study was designed to assess WJ for ESD submucosal lifting and dissection. An experimental, randomized comparative, "in vivo" nonsurvival animal study on 12 pigs was designed. Stomach mucosal areas were delineated and resected using three ESD techniques: technique A-syringe injection and IT knife dissection; technique B-WJ continuous injection and IT knife dissection; technique C-WJ injection and WJ pulsed dissection. Injection and dissection speeds and complications rates were assessed. Water jet continuous injection is faster than syringe injection (B faster than A, p = 0.001 and B nonsignificantly faster than C, p = 0.06). IT knife dissection is significantly faster after WJ continuous injection (B faster than A, p = 0.003). WJ pulsed dissection is significantly slower than IT knife dissection (C slower than A and B, both p < 0.001). The overall procedure speed was significantly higher and the immediate bleedings rate was significantly lower for technique B than A and C (overall procedure speed p = 0.001, immediate bleedings p = 0.032 and 0.038 respectively). There were no perforations with any technique. Water jet fluid continuous injection speeds up ESD, whereas pulsed WJ dissection does not.

  3. [Urodynamic study of obstruction induced by vesicoureteral reflux surgery with submucosal advance in beagle female dogs].

    Science.gov (United States)

    Guillonneau, B; Wetzel, O; Buzelin, J M

    1995-12-01

    The treatment of veslcoureteric reflux by submucosal advancement is effective in human clinical practice on nondilated refluxing ureters, with a low morbidity. In contrast, the results of this technique in the presence of concomitant disease such as megaureter appear to be less favourable and could be due to obstruction induced by the reflux surgery. The objective of this study was to evaluate the urodynamic modifications of ureterovesical reimplantation in 10 female Beagle dogs. Left ureterovesical reimplantation by submucosal ureteric advancement was performed in each animal which constituted its own control. The morphological results were assessed by intravenous urography and retrograde cystography. The urodynamic study was conducted during another surgical operation performed, on average, around the 18th postoperative week. A 6F two-channel probe was inserted on each ureter: while a pump delivered a constant infusion (2 then 5 ml/min) into one channel, the ureteric pressure was measured by the other channel. The bladder pressure was recorded by a bladder catheter. For each infusion rate, the increased pressure in the reimplanted ureter was compared to that measured in the control ureter, as a function of the bladder pressure. The subsequent morphological evaluation demonstrated the absence of any repercussions on the upper urinary tract and the absence of vesicoureteric reflux and paraureteric diverticulum. An initial increase in the basal ureteric pressure was observed at the beginning of the infusion and was significantly higher in the operated ureter than in the control ureter (for an infusion rate of 2 then 5 ml/min, p = 0.0008 and 0.00029, respectively). The mean ureteric pressures increased in parallel, but those recorded in the reimplanted ureter were significantly higher than those recorded in the control ureter (p < 0.01). Ureteric pressure peaks were only recorded on the reimplanted left ureter at an infusion rate of 2 ml/min. These results suggest

  4. Submucosal Diclofenac for Acute Postoperative Pain in Third Molar Surgery: A Randomized, Controlled Clinical Trial.

    Science.gov (United States)

    Gorecki, P; Rainsford, K D; Taneja, P; Bulsara, Y; Pearson, D; Saund, D; Ahmed, B; Dietrich, T

    2017-12-01

    Diclofenac sodium is a widely used nonsteroidal anti-inflammatory drug (NSAID) for relief of inflammatory pain. A recent formulation combines this drug with hydroxypropyl-β-cyclodextrin (HPβCD) to improve its solubility and to enable subcutaneous administration. Previous studies confirmed the efficacy of this combination. This study's aim was to evaluate the efficacy, safety, and local tolerability of diclofenac HPβCD administered as a local submucosal injection prior to lower third molar surgery. We conducted a prospective, randomized, double-blind, placebo-controlled, parallel-group phase II single-center study. Seventy-five patients requiring mandibular third molar surgery were randomized into 1 of 5 groups: 5 mg/1 mL diclofenac HPβCD, 12.5 mg/1 mL diclofenac HPβCD, 25 mg/1 mL diclofenac HPβCD, 50 mg/1 mL diclofenac HPβCD, or 1 mL placebo. The respective study drug was injected into the mucosal tissue surrounding the surgical site prior to surgery following achievement of local anesthesia. The primary outcome measure was the area under the curve (AUC) of cumulative pain scores from end of surgery to 6 h postsurgery. This demonstrated a global treatment effect between the active groups and placebo, hence confirming the study drug's efficacy ( P = 0.0126). Secondary outcome measures included the time until onset of pain and the time until patients required rescue medication, both showing statistical significance of the study drug compared to placebo ( P < 0.0161 and P < 0.0001, respectively). The time until rescue medication ranged between 7.8 h (for 25 mg/1 mL diclofenac HPβCD) and 16 h (for 50 mg/1 mL diclofenac HPβCD). Interestingly, the 5-mg/1-mL solution appeared superior to the 12.5-mg/1-mL and 25-mg/1-mL solutions (time until rescue medication = 12.44 h). A total of 14% of patients experienced minor adverse drug reactions (ADRs), of which 2 cases demonstrated flap necrosis. These resolved without further intervention. The study results overall

  5. Tumor budding and E-cadherin expression are useful predictors of nodal involvement in T1 esophageal squamous cell carcinoma.

    Science.gov (United States)

    Nakagawa, Yasuo; Ohira, Masaichi; Kubo, Naoshi; Yamashita, Yoshito; Sakurai, Katsunobu; Toyokawa, Takahiro; Tanaka, Hiroaki; Muguruma, Kazuya; Shibutani, Masatsune; Yamazoe, Sadaaki; Kimura, Kenjiro; Nagahara, Hisashi; Amano, Ryosuke; Ohtani, Hiroshi; Yashiro, Masakazu; Maeda, Kiyoshi; Hirakawa, Kosei

    2013-11-01

    Endoscopic treatment has been increasingly used for T1 esophageal squamous cell carcinoma (ESCC). However, this therapy is sometimes incomplete if the depth of the T1 primary tumor reaches the muscularis mucosae or submucosal layer because these tumors have a relatively high incidence of lymph node metastasis. However, to our knowledge, no previous reports on the prediction of nodal metastasis determined by evaluating primary tumor specimens of patients with ESCC are available. A total of 55 patients with T1 ESCC invading as deep as the submucosal layer who underwent curative esophagectomy were examined. We investigated the significance of the immunohistochemical staining of Vascular endothelial growth factor-C (VEGF-C) and E-cadherin in the primary tumor and Tumor budding for prediction of nodal metastasis. Metastasis to the regional lymph nodes was observed in 26 cases (47.3%) in this setting. VEGF-C expression and reduced E-Cadherin expression in the primary tumor was observed in 32 (58.1%) and 38 cases (69.1%), respectively. High-grade tumor budding was observed in 29 cases (52.7%). E-cadherin expression and tumor budding were closely correlated with nodal metastasis (p=0.04 and tumor budding was significantly correlated (ptumor budding and E-cadherin expression for nodal metastasis were 67.3% and 65.4% respectively, comparable with the one of lymphatic involvement (63%). Tumor budding (ptumor budding are observed in primary tumor specimen.

  6. Bone tumor

    Science.gov (United States)

    Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor; Bone tumor - benign ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects passed down ...

  7. Distribution of voltage-dependent and intracellular Ca2+ channels in submucosal neurons from rat distal colon.

    Science.gov (United States)

    Rehn, Matthias; Bader, Sandra; Bell, Anna; Diener, Martin

    2013-09-01

    We recently observed a bradykinin-induced increase in the cytosolic Ca2+ concentration in submucosal neurons of rat colon, an increase inhibited by blockers of voltage-dependent Ca2+ (Ca(v)) channels. As the types of Ca(v) channels used by this part of the enteric nervous system are unknown, the expression of various Ca(v) subunits has been investigated in whole-mount submucosal preparations by immunohistochemistry. Submucosal neurons, identified by a neuronal marker (microtubule-associated protein 2), are immunoreactive for Ca(v)1.2, Ca(v)1.3 and Ca(v)2.2, expression being confirmed by reverse transcription plus the polymerase chain reaction. These data agree with previous observations that the inhibition of L- and N-type Ca2+ currents strongly inhibits the response to bradykinin. However, whole-cell patch-clamp experiments have revealed that bradykinin does not enhance Ca2+ inward currents under voltage-clamp conditions. Consequently, bradykinin does not directly interact with Ca(v) channels. Instead, the kinin-induced Ca2+ influx is caused indirectly by the membrane depolarization evoked by this peptide. As intracellular Ca2+ channels on Ca(2+)-storing organelles can also contribute to Ca2+ signaling, their expression has been investigated by imaging experiments and immunohistochemistry. Inositol 1,4,5-trisphosphate (IP3) receptors (IP3R) have been functionally demonstrated in submucosal neurons loaded with the Ca(2+)-sensitive fluorescent dye, fura-2. Histamine, a typical agonist coupled to the phospholipase C pathway, induces an increase in the fura-2 signal ratio, which is suppressed by 2-aminophenylborate, a blocker of IP3 receptors. The expression of IP3R1 has been confirmed by immunohistochemistry. In contrast, ryanodine, tested over a wide concentration range, evokes no increase in the cytosolic Ca2+ concentration nor is there immunohistochemical evidence for the expression of ryanodine receptors in these neurons. Thus, rat submucosal neurons are equipped

  8. Risk factors of delayed ulcer healing after gastric endoscopic submucosal dissection.

    Science.gov (United States)

    Lim, Joo Hyun; Kim, Sang Gyun; Choi, Jeongmin; Im, Jong Pil; Kim, Joo Sung; Jung, Hyun Chae

    2015-12-01

    Although post-endoscopic submucosal dissection (ESD) iatrogenic ulcer is known to heal faster than peptic ulcer, some iatrogenic ulcers show delayed healing. The aim of this study was to clarify risk factors of delayed ulcer healing after gastric ESD. We retrospectively reviewed medical records of all patients who had ESD for gastric neoplasms (866 adenomas and 814 early gastric cancers) between January 2005 and February 2011. Of 1680 subjects, 95 had delayed ulcer healing in 3-month follow-up. Multivariate analysis showed that diabetes (OR 1.743; 95% CI 1.017-2.989, p = 0.043), coagulation abnormality (OR 3.195; 95% CI 1.535-6.650, p = 0.002), specimen size greater than 4 cm (OR 2.999; 95% CI 1.603-5.611, p = 0.001), and electrocoagulation (OR 7.149; 95% CI 1.738-29.411, p = 0.006) were revealed to be independent risk factors of delayed ulcer healing. Meanwhile, persistent Helicobacter pylori infection was not related to the delayed ulcer healing. Large iatrogenic ulcer by ESD with massive hemostasis, especially in patients with diabetes mellitus or coagulation abnormalities, tends to take more than 3 months to heal. For such cases, initial dosage increment of PPI or addition of other anti-ulcer agents after ESD may be beneficial.

  9. Ductal metaplasia in oesophageal submucosal glands is associated with inflammation and oesophageal adenocarcinoma.

    Science.gov (United States)

    Garman, Katherine S; Kruger, Leandi; Thomas, Samantha; Swiderska-Syn, Marzena; Moser, Barry K; Diehl, Anna Mae; McCall, Shannon J

    2015-12-01

    Recent studies have suggested that oesophageal submucosal gland (ESMG) ducts harbour progenitor cells that may contribute to oesophageal metaplasia. Our objective was to determine whether histological differences exist between the ESMGs of individuals with and without oesophageal adenocarcinoma (EAC). We performed histological assessment of 343 unique ESMGs from 30 control patients, 24 patients with treatment-naïve high-grade columnar dysplasia (HGD) or EAC, and 23 non-EAC oesophagectomy cases. A gastrointestinal pathologist assessed haematoxylin and eosin-stained ESMG images by using a scoring system that assigns individual ESMG acini to five histological types (mucous, serous, oncocytic, dilated, or ductal metaplastic). In our model, ductal metaplastic acini were more common in patients with HGD/EAC (12.7%) than in controls (3.5%) (P = 0.006). We also identified greater proportions of acini with dilation (21.9%, P metaplasia (4.3%, P = 0.001) in non-EAC oesophagectomy cases than in controls. Ductal metaplasia tended to occur in areas of mucosal ulceration or tumour. We found a clear association between ductal metaplastic ESMG acini and HGD/EAC. Non-EAC cases had dilated acini and some ductal dilation. Because ESMGs and ducts harbour putative progenitor cells, these associations could have significance for understanding the pathogenesis of EAC. © 2015 John Wiley & Sons Ltd.

  10. Simplified magnetic anchor-guided endoscopic submucosal dissection in dogs (with videos).

    Science.gov (United States)

    Matsuzaki, Ippei; Miyahara, Ryoji; Hirooka, Yoshiki; Funasaka, Kohei; Furukawa, Kazuhiro; Ohno, Eizaburo; Nakamura, Masanao; Kawashima, Hiroki; Maeda, Osamu; Watanabe, Osamu; Ando, Takafumi; Kobayashi, Makoto; Goto, Hidemi

    2014-10-01

    Magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD) was developed to reduce adverse events such as bleeding and perforation and to facilitate ESD. However, the external electromagnet required miniaturization to make it suitable for daily clinical practice. To evaluate the feasibility of simplified MAG-ESD using permanent magnets. Case series. Nagoya University Hospital. Beagle dogs. The simplified MAG-ESD was performed on 10 representative areas of the stomachs of beagle dogs. The magnetic anchor consisted of an internal magnet attached to a hemoclip. The external and internal magnets were made from the rare earth neodymium. The feasibility of countertraction with good visualization using simplified MAG-ESD. The rate of perforation, the time required for preparation, and attaching the magnetic anchor were also evaluated. All lesions were successfully resected without perforation. The magnetic anchor could be controlled easily, and direct visualization was maintained by adequate counter traction. Preparing the magnetic anchor and grasping the mucosal edge using the hemoclip was easy and required a median of only 4 minutes (range, 2-7 minutes). Animal experiment, low number and lesion size. This simplified MAG-ESD is feasible and allowed excellent visualization in the dog stomach. The feasibility of this system should be assessed in humans. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  11. CGRP induction in cystic fibrosis airways alters the submucosal gland progenitor cell niche in mice.

    Science.gov (United States)

    Xie, Weiliang; Fisher, John T; Lynch, Thomas J; Luo, Meihui; Evans, Turan I A; Neff, Traci L; Zhou, Weihong; Zhang, Yulong; Ou, Yi; Bunnett, Nigel W; Russo, Andrew F; Goodheart, Michael J; Parekh, Kalpaj R; Liu, Xiaoming; Engelhardt, John F

    2011-08-01

    In cystic fibrosis (CF), a lack of functional CF transmembrane conductance regulator (CFTR) chloride channels causes defective secretion by submucosal glands (SMGs), leading to persistent bacterial infection that damages airways and necessitates tissue repair. SMGs are also important niches for slow-cycling progenitor cells (SCPCs) in the proximal airways, which may be involved in disease-related airway repair. Here, we report that calcitonin gene-related peptide (CGRP) activates CFTR-dependent SMG secretions and that this signaling pathway is hyperactivated in CF human, pig, ferret, and mouse SMGs. Since CGRP-expressing neuroendocrine cells reside in bronchiolar SCPC niches, we hypothesized that the glandular SCPC niche may be dysfunctional in CF. Consistent with this hypothesis, CFTR-deficient mice failed to maintain glandular SCPCs following airway injury. In wild-type mice, CGRP levels increased following airway injury and functioned as an injury-induced mitogen that stimulated SMG progenitor cell proliferation in vivo and altered the proliferative potential of airway progenitors in vitro. Components of the receptor for CGRP (RAMP1 and CLR) were expressed in a very small subset of SCPCs, suggesting that CGRP indirectly stimulates SCPC proliferation in a non-cell-autonomous manner. These findings demonstrate that CGRP-dependent pathways for CFTR activation are abnormally upregulated in CF SMGs and that this sustained mitogenic signal alters properties of the SMG progenitor cell niche in CF airways. This discovery may have important implications for injury/repair mechanisms in the CF airway.

  12. Second-look endoscopy and factors associated with delayed bleeding after endoscopic submucosal dissection.

    Science.gov (United States)

    Kim, Su-Jin; Choi, Cheol-Woong; Kang, Dae-Hwan; Kim, Hyung-Wook; Park, Su-Bum

    2016-02-10

    Endoscopic submucosal dissection (ESD) is a widely used procedure as curative treatment for superficial gastric neoplasms, including early gastric cancer without lymph node metastasis. However, ESD requires advanced endoscopic skill and there is a major concern regarding complications from bleeding. So far, extensive efforts have been made to develop strategies to reduce post-ESD bleeding. Use of proton pump inhibitors and coagulating exposed vessels on the ulcer floor after ESD are strategies known to reduce the risk of delayed bleeding. Second-look endoscopy (SLE) is also carried out to reduce delayed bleeding following ESD in many institutions. However, the incidence of bleeding still remains around 5%, and further measures are needed to reduce delayed bleeding after gastric ESD. Recently, three randomized studies indicated that routine SLE was unnecessary. Although routine SLE may not be recommended for all patients after gastric ESD, SLE might be an important tool for the prevention of the delayed bleeding in selected high-risk patients. Thus, the identification of the risk factors, such as large size of resected specimen and treatment with multiple antiplatelet medications, may help to further guide clinicians in deciding whether to perform SLE. Studies carried out on larger cohorts are necessary to clarify the efficacy of SLE after ESD in the prevention of post-ESD bleeding in potentially high-risk patients.

  13. Source of the fluid component of secretions from tracheal submucosal glands in cats.

    Science.gov (United States)

    Corrales, R J; Nadel, J A; Widdicombe, J H

    1984-04-01

    The idea that the fluid component of cat tracheal submucosal gland secretions is produced by Na-linked secretion of Cl was tested. Gland secretion was stimulated with phenylephrine; gland fluid flow, net salt movement, and output of 35SO4-labeled macromolecules were measured. With CI, I, NO3, or Br as the major anion, phenylephrine caused equal increases in gland flow and output of 35S-labeled macromolecules while increasing net transepithelial 22Na movement from 0 to about 10 mu eq X cm-2 X h-1. With the impermeant gluconate as a major anion, phenylephrine caused the same increase in output of 35S label, a smaller increase in gland flow, and had no effect on net 22Na movement. Short circuiting in the presence of Cl, or high concentrations of the loop diuretics, furosemide or bumetanide, did not alter the actions of phenylephrine. Ouabain or replacement of Na by choline or Li abolished all secretory effects of phenylephrine. We conclude that active Cl secretion is not responsible for the transepithelial flows of salt and water induced by phenylephrine. Instead, these flows may be secondary to the release of osmotically active components of the secretory granules.

  14. Clinical application of suction-tube-assisted septal submucosal dissection for endoscopic septoplasty.

    Science.gov (United States)

    Lai, Wen-Sen; Lin, Yuan-Yung; Shih, Cheng-Ping; Chen, Hsin-Chien; Yang, Pei-Lin; Chu, Yueng-Hsiang; Yang, Jinn-Moon; Lee, Jih-Chin

    2017-03-01

    Endoscopic septoplasty has become the favored approach for the treatment of a deviated septum. Careful septal dissection results in less bleeding, clear endoscopic view, shortened operative time, and fewer postoperative complications. We describe our 5-year experience of using an 8 French Frazier suction tube for submucosal dissection compared with the traditional septoplasty. A total of 434 patients who underwent septoplasty were recruited. The patients in the study were divided into two Groups 1 and 2 based on the employed surgical techniques to treat deviated nasal septum: traditional septoplasty (Group 1: 105 patients) and suction-tube-assisted endoscopic septoplasty (Group 2: 329 patients). All the patients were followed up for a minimum of 6 months. No statistically significant differences could be traced between the groups in any demographic factor, regarding the gender, age, and the intraoperative and postoperative complications. A significantly shorter operative time was found in Group 2 (P suction-tube-assisted dissection technique is found to be a surgical alternative, effective with a significantly shorter operating time, and economical option in septal surgery.

  15. Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in remnant stomach or gastric tube.

    Science.gov (United States)

    Nishide, N; Ono, H; Kakushima, N; Takizawa, K; Tanaka, M; Matsubayashi, H; Yamaguchi, Y

    2012-06-01

    Little information exists regarding the optimal treatment of early gastric cancer (EGC) in a remnant stomach or gastric tube. The aim of this study was to assess the feasibility and clinical outcomes of endoscopic submucosal dissection (ESD) for EGC in a remnant stomach and gastric tube. Between September 2002 and December 2009, ESD was performed in 62 lesions in 59 patients with EGC in a remnant stomach (48 lesions) or gastric tube (14 lesions). Clinicopathological data were retrieved retrospectively to assess the en bloc resection rate, complications, and outcomes. Treatment results were assessed according to the indications for endoscopic resection, and were compared with those of ESD performed in a whole stomach during the same study period. The en bloc resection rates for lesions within the standard and expanded indication were 100 % and 93 %, respectively. Postoperative bleeding occurred in five patients (8 %). The perforation rate was significantly higher (18 %, 11 /62) than that of ESD in a whole stomach (5 %, 69 /1479). Among the perforation cases, eight lesions involved the anastomotic site or stump line, and ulcerative changes were observed in five lesions. The 3-year overall survival rate was 85 %, with eight deaths due to other causes and no deaths from gastric cancer. A high en bloc resection rate was achieved by ESD for EGC in a remnant stomach or gastric tube; however, this procedure is still technically demanding due to the high complication rate of perforation. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Efficient Gene Delivery to Pig Airway Epithelia and Submucosal Glands Using Helper-Dependent Adenoviral Vectors

    Directory of Open Access Journals (Sweden)

    Huibi Cao

    2013-01-01

    Full Text Available Airway gene delivery is a promising strategy to treat patients with life-threatening lung diseases such as cystic fibrosis (CF. However, this strategy has to be evaluated in large animal preclinical studies in order to translate it to human applications. Because of anatomic and physiological similarities between the human and pig lungs, we utilized pig as a large animal model to examine the safety and efficiency of airway gene delivery with helper-dependent adenoviral vectors. Helper-dependent vectors carrying human CFTR or reporter gene LacZ were aerosolized intratracheally into pigs under bronchoscopic guidance. We found that the LacZ reporter and hCFTR transgene products were efficiently expressed in lung airway epithelial cells. The transgene vectors with this delivery can also reach to submucosal glands. Moreover, the hCFTR transgene protein localized to the apical membrane of both ciliated and nonciliated epithelial cells, mirroring the location of wild-type CF transmembrane conductance regulator (CFTR. Aerosol delivery procedure was well tolerated by pigs without showing systemic toxicity based on the limited number of pigs tested. These results provide important insights into developing clinical strategies for human CF lung gene therapy.

  17. Efficient gene delivery to pig airway epithelia and submucosal glands using helper-dependent adenoviral vectors.

    Science.gov (United States)

    Cao, Huibi; Machuca, Tiago N; Yeung, Jonathan C; Wu, Jing; Du, Kai; Duan, Cathleen; Hashimoto, Kohei; Linacre, Virginia; Coates, Allan L; Leung, Kitty; Wang, Jian; Yeger, Herman; Cutz, Ernest; Liu, Mingyao; Keshavjee, Shaf; Hu, Jim

    2013-10-08

    Airway gene delivery is a promising strategy to treat patients with life-threatening lung diseases such as cystic fibrosis (CF). However, this strategy has to be evaluated in large animal preclinical studies in order to translate it to human applications. Because of anatomic and physiological similarities between the human and pig lungs, we utilized pig as a large animal model to examine the safety and efficiency of airway gene delivery with helper-dependent adenoviral vectors. Helper-dependent vectors carrying human CFTR or reporter gene LacZ were aerosolized intratracheally into pigs under bronchoscopic guidance. We found that the LacZ reporter and hCFTR transgene products were efficiently expressed in lung airway epithelial cells. The transgene vectors with this delivery can also reach to submucosal glands. Moreover, the hCFTR transgene protein localized to the apical membrane of both ciliated and nonciliated epithelial cells, mirroring the location of wild-type CF transmembrane conductance regulator (CFTR). Aerosol delivery procedure was well tolerated by pigs without showing systemic toxicity based on the limited number of pigs tested. These results provide important insights into developing clinical strategies for human CF lung gene therapy.Molecular Therapy-Nucleic Acids (2013) 2, e127; doi:10.1038/mtna.2013.55; published online 8 October 2013.

  18. Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer.

    Science.gov (United States)

    Toya, Yosuke; Endo, Masaki; Nakamura, Shotaro; Akasaka, Risaburo; Kosaka, Takashi; Yanai, Shunichi; Kawasaki, Keisuke; Koeda, Keisuke; Sugai, Tamotsu; Matsumoto, Takayuki

    2017-06-01

    There has been little information about the long-term outcomes of patients with early gastric cancer (EGC) treated by non-curative endoscopic submucosal dissection (ESD) with negative resected margins (R0 resection). We aimed to compare the clinical outcomes of non-curative ESD with R0 resection between patients who underwent additional gastrectomy and those who did not. Among EGC patients treated by ESD from 2002 to 2010, 66 patients were treated by non-curative ESD with R0 resection. Patients received either additional gastrectomy (group A, n = 45) or were followed up without gastrectomy (group B, n = 21). The clinicopathologic findings and the subsequent clinical course were compared between the 2 groups. Patients in group A were younger than those in group B (68.0 vs 71.0 years, P = .006). The follow-up period was longer in group A than in group B (7.8 vs 5.9 years, P = .011). The percentage of patients who died of any cause was not statistically lower in group A than in group B (13.3% vs 33.3%, P = .06). Although the overall survival rate was higher in group A than in group B (93.3% vs 76.2%, P = .028), disease-specific survival rates did not differ between the 2 groups (97.8% vs 100%, P = .495). A Cox proportional hazards model showed that gastrectomy was not an independent factor associated with overall survival. Careful follow-up may be an alternative strategy to gastrectomy for a subgroup of patients treated by non-curative ESD with R0 resection. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  19. Efficacy and safety of Helicobacter pylori eradication therapy immediately after endoscopic submucosal dissection.

    Science.gov (United States)

    Takahashi, Yoshiaki; Takeuchi, Toshihisa; Kojima, Yuichi; Nagami, Yasuaki; Ominami, Masaki; Uedo, Noriya; Hamada, Kenta; Suzuki, Haruhisa; Oda, Ichiro; Miyaoka, Youichi; Yamanouchi, Satoshi; Tokioka, Satoshi; Tomatsuri, Naoya; Yoshida, Norimasa; Naito, Yuji; Nonaka, Takashi; Kodashima, Shinya; Ogata, Shinichi; Hongo, Yasushi; Oshima, Tadayuki; Li, Zhaoliang; Shibagaki, Kotaro; Oikawa, Tomoyuki; Tominaga, Kazunari; Higuchi, Kazuhide

    2017-12-19

    In the treatment of patients after endoscopic submucosal dissection (ESD), there is no consensus on the optimum time to start Helicobacter pylori (H. pylori) eradication therapy or on whether eradication therapy improves ulcer healing rate after ESD. The aim of this study was to examine the effect of immediate eradication of H. pylori on ulcer healing after ESD in patients with early gastric neoplasms. A total of 330 patients who underwent ESD for early gastric neoplasms were enrolled. Patients were assigned to either H. pylori eradication group (Group A: H. pylori eradication + proton pump inhibitor 7 weeks) or non-eradication group (Group B: proton pump inhibitor 8 weeks). The primary endpoint was gastric ulcer healing rate (Group A vs Group B) determined on Week 8 after ESD. Patients in Group A failed to meet non-inferiority criteria for ulcer scarring rate after ESD compared with that in Group B (83.0% vs 86.5%, p for non-inferiority=0.0599, 95% CI: -11.7% to 4.7%). There were, however, neither large differences between the two groups in the ulcer scarring rate nor the safety profile. This study failed to demonstrate the non-inferiority of immediate H. pylori eradication therapy after ESD to the non-eradication therapy in the healing rate of ESD-caused ulcers. However, since the failure is likely to attributable to small number of patients enrolled, immediate eradication therapy may be a treatment option for patients after ESD without adverse effects on eradication therapy in comparison with the standard therapy. This article is protected by copyright. All rights reserved.

  20. The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey.

    Science.gov (United States)

    Barret, Maximilien; Lepilliez, Vincent; Coumaros, Dimitri; Chaussade, Stanislas; Leblanc, Sarah; Ponchon, Thierry; Fumex, Fabien; Chabrun, Edouard; Bauret, Paul; Cellier, Christophe; Coron, Emmanuel; Bichard, Philippe; Bulois, Philippe; Charachon, Antoine; Rahmi, Gabriel; Bellon, Serge; Lerhun, Marc; Arpurt, Jean-Pierre; Koch, Stéphane; Napoleon, Bertrand; Vaillant, Eric; Esch, Anouk; Farhat, Said; Robin, Francoise; Kaddour, Nadira; Prat, Frédéric

    2017-02-01

    Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time. All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008-2010 period. Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010-2013 vs 32.1 ± 21 for 2008-2010 (p = 0.004). En bloc resection improved from 77.1% to 91.7% (p < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% (p = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 (p < 0.0001), with bleeding decreasing from 11.2% to 4.7% (p = 0.01) and perforations from 18.1% to 8.1% (p = 0.002) over time. No procedure-related mortality was recorded. In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.

  1. Quality of Life after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Prospective Multicenter Cohort Study

    Science.gov (United States)

    Kim, Sang Gyun; Ji, Seon Mi; Lee, Na Rae; Park, Seung-Hee; You, Ji Hye; Choi, Il Ju; Lee, Wan Sik; Park, Seun Ja; Lee, Jun Haeng; Seol, Sang-Yong; Kim, Ji Hyun; Lim, Chul-Hyun; Cho, Joo Young; Kim, Gwang Ha; Chun, Hoon Jai; Lee, Yong Chan; Jung, Hwoon-Yong; Kim, Jae J.

    2017-01-01

    Background/Aims Endoscopic submucosal dissection (ESD) has been an established treatment for indicated early gastric cancer (EGC) without deterioration of quality of life (QOL) compared with surgical resection. The aim of this study was to evaluate long-term QOL in patients undergoing ESD for EGC. Methods Patients scheduled to undergo curative ESD for EGC were prospectively enrolled from 12 institutions between May 2010 and December 2011. Assessments of QOL with Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and a gastric cancer-specific questionnaire (STO22) were performed at baseline and at 7 days, 3 months, and 6 months after ESD. Results A total of 666 subjects were assessed for QLQ-C30 and QLQ-STO22. The mean QLQ-C30 score was 69.5 at baseline, 68.8 at 7 days, 73.1 at 3 months, and 73.2 at 6 months. The global health status on the EORTC QLQ-C30 was significantly improved after 3 and 6 months (p=0.0003 and p<0.0001, respectively). The QLQ-C30 and STO22 scores were not significantly different, or they only slightly deteriorated between before and immediately after ESD, but they were significantly improved after 3 and 6 months (p<0.05). Conclusions QOL did not deteriorate immediately after ESD, and it improved more significantly at up to 6 months in patients who underwent curative ESD for EGC without significant complications. PMID:27282267

  2. Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer.

    Science.gov (United States)

    Kishida, Yoshihiro; Kakushima, Naomi; Kawata, Noboru; Tanaka, Masaki; Takizawa, Kohei; Imai, Kenichiro; Hotta, Kinichi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

    2015-10-01

    Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD. This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed. The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2-9 procedures) and at a median of 18 days (range 8-29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6-57) compared with those without perforation (7, range 1-70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively). The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.

  3. Magnetic anchor-guided endoscopic submucosal dissection for gastric lesions (with video).

    Science.gov (United States)

    Matsuzaki, Ippei; Hattori, Masashi; Hirose, Ken; Esaki, Masaya; Yoshikawa, Masakatsu; Yokoi, Takio; Kobayashi, Makoto; Miyahara, Ryoji; Hirooka, Yoshiki; Goto, Hidemi

    2018-01-15

    The feasibility of magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD) using a neodymium magnet for gastric lesions has not been clarified. The aim of study was to evaluate the feasibility of MAG-ESD using neodymium magnets while treating gastric lesions. This prospective trial was conducted at the Yamashita Hospital. The MAG-ESD was performed for 50 gastric lesions using an insulated-tip knife. The magnetic anchor consisted of an internal neodymium magnet attached to a hemoclip with 3-0 silk. The external and internal magnets were made from the neodymium magnet. The feasibility of traction using MAG-ESD, en bloc resection rate, complete en bloc resection rate, time required for preparation and attaching the magnetic anchor, procedure time, rate of retrieval of the magnetic anchors and adverse events were evaluated. Fifty patients (median lesion size 20 mm; range 5-100 mm) were enrolled. MAG-ESDs were successfully performed for all 50 gastric lesions. Adequate counter traction was obtained using the external magnet. En bloc resections were achieved and complete en bloc resections confirmed in all cases without adverse events. Attaching the magnetic anchor required a median of 6 minutes (range 2-14 minutes). The median procedure time was 49 minutes (range 15-301 minutes), and the magnetic anchors could be retrieved in all cases. This study clearly demonstrated the feasibility of this MAG-ESD in the stomach. We hope that this procedure will facilitate the resection of difficult lesions. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  4. Clinical significance of surgery for gastric submucosal tumours with size enlargement during watchful waiting period.

    Science.gov (United States)

    Miyazaki, Yasuhiro; Nakajima, Kiyokazu; Kurokawa, Yukinori; Takahashi, Tsuyoshi; Takiguchi, Shuji; Miyata, Hiroshi; Yamasaki, Makoto; Hirota, Seiichi; Nishida, Toshirou; Mori, Masaki; Doki, Yuichiro

    2013-08-01

    The true impact of surgery for small, asymptomatic and biopsy-negative gastric submucosal tumours (SMTs) with size enlargement during 'watchful waiting' period has not been fully understood. From 2005 to 2012, 100 patients with gastric SMTs underwent surgery. Twenty-three of them with size enlargement during observation period were enrolled in the retrospective analysis. Data included clinicopathologic findings, genetic findings, operative outcomes and prognoses. All patients (13 males, 10 females), with median age of 54 (41-71), had their lesions detected by routine health check-up (n=21) or incidentally (2). The tumours were 1.8 (0.5-4.0)cm in size at their initial detection, and enlarged up to 3.2 (2.0-7.0)cm at the operation during 63.0 (14.6-233.7) months. As surgical procedure, laparoscopic partial gastrectomy accounted for the majority (78.3%). Histologic examination revealed gastrointestinal stromal tumour (GIST) (21) and schwannoma (2). Although 16 out of 21 GISTs were categorised into 'Very low' (1), and 'Low' (13) risk according to Fletcher's classification, 'Intermediate' (5) and 'High' (2) risk were identified in the series. No recurrences/metastases were noted in 23.2 (0.9-87) months of postoperative follow-up. Our study revealed the existence of high mitotic GISTs in asymptomatic, small gastric SMTs with size enlargement, and laparoscopic surgery was safely applied to majority of those cases. Prompt surgical intervention should therefore be considered for those lesions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Examining the Efficacy of the Modified Story Memory Technique (mSMT) in Persons With TBI Using Functional Magnetic Resonance Imaging (fMRI): The TBI-MEM Trial.

    Science.gov (United States)

    Chiaravalloti, Nancy D; Dobryakova, Ekaterina; Wylie, Glenn R; DeLuca, John

    2015-01-01

    New learning and memory deficits are common following traumatic brain injury (TBI). Yet few studies have examined the efficacy of memory retraining in TBI through the most methodologically vigorous randomized clinical trial. Our previous research has demonstrated that the modified Story Memory Technique (mSMT) significantly improves new learning and memory in multiple sclerosis. The present double-blind, placebo-controlled, randomized clinical trial examined changes in cerebral activation on functional magnetic resonance imaging following mSMT treatment in persons with TBI. Eighteen individuals with TBI were randomly assigned to treatment (n = 9) or placebo (n = 9) groups. Baseline and follow-up functional magnetic resonance imaging was collected during a list-learning task. Significant differences in cerebral activation from before to after treatment were noted in regions belonging to the default mode network and executive control network in the treatment group only. Results are interpreted in light of these networks. Activation differences between the groups likely reflect increased use of strategies taught during treatment. This study demonstrates a significant change in cerebral activation resulting from the mSMT in a TBI sample. Findings are consistent with previous work in multiple sclerosis. Behavioral interventions can show significant changes in the brain, validating clinical utility.

  6. Intestinal Neuronal Dysplasia-Like Submucosal Ganglion Cell Hyperplasia at the Proximal Margins of Hirschsprung Disease Resections.

    Science.gov (United States)

    Swaminathan, Maya; Oron, Assaf P; Chatterjee, Sumantra; Piper, Hannah; Cope-Yokoyama, Sandy; Chakravarti, Aravinda; Kapur, Raj P

    2015-01-01

    Intestinal neuronal dysplasia type B (IND) denotes an increased proportion of hyperplastic submucosal ganglia, as resolved histochemically in 15-μm-thick frozen sections. IND has been reported proximal to the aganglionic segment in patients with Hirschsprung disease (HSCR) and is putatively associated with a higher rate of postsurgical dysmotility. We developed and validated histological criteria to diagnose IND-like submucosal ganglion cell hyperplasia (IND-SH) in paraffin sections and used the approach to study the incidence and clinical and/or genetic associations of IND-SH at the proximal margins of HSCR pull-through resection specimens. Full-circumference paraffin sections from the proximal margins of 64 HSCR colonic pull-through specimens and 24 autopsy controls were immunostained for neuron-specific Hu antigen, and nucleated ganglion cells in each submucosal ganglion were counted. In controls, an age-related decline in the relative abundance of "giant" ganglia (≥7 nucleated Hu-positive [Hu+] ganglion cells) was observed. A conservative diagnostic threshold for IND-SH (control mean ± 3× standard deviation) was derived from 15 controls less than 25 weeks of age. No control exceeded this threshold, whereas in the same age range, IND-SH was observed at the proximal margins in 15% (7 of 46) of HSCR resections, up to 15 cm proximal to the aganglionic segment. No significant correlation was observed between IND-SH and length of or distance from the aganglionic segment, sex, trisomy 21, RET or SEMA3C/D polymorphisms, or clinical outcome, but analysis of more patients, with better long-term follow-up will be required to clarify the significance of this histological phenotype.

  7. Conducta alimentaria y perfil glucémico en dos líneas de ratas con diabetes genética: eSS y eSMT.

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    Silvana Marisa Montenegro

    2005-12-01

    Full Text Available Introducción. La alimentación puede agravar la diabetes de humanos y modelos animales. Entre ellos, la rata eSMT presenta un curso más exacerbado y mayor biomasa que la línea parental eSS. Objetivo. Estudiar la conducta alimentaria de ratas macho eSMT y eSS ante oferta ilimitada y bajo restricción alternada, analizando su incidencia sobre el peso y la glucemia. Materiales y métodos. Se registró el consumo ad libitum en etapas de crecimiento y mantenimiento. Un grupo de eSMT recibió durante 5 semanas a partir del destete, una dieta restringida intermitente seguida de oferta ilimitada, y otro fue restringido hasta el año de edad, midiéndose el peso y el perfil glucémico en distintas edades. Resultados. Durante el crecimiento, eSMT aumentó de peso más que eSS con ingestas similares, y en la etapa de mantenimiento sustentó mayor biomasa con menor consumo. La restricción intermitente posterior al destete indujo un patrón de crecimiento más lento y menor peso adulto. A los 5 meses presentaron valores de G0 normales (85±12 mg/dl y los controles mostraron cifras alteradas (119±14 mg/dl. En los animales restringidos la posterior oferta ilimitada produjo glucemias de ayuno compatibles con diabetes (163±25 mg/dl y un incremento ponderado 75% superior a los alimentados ad libitum. Conclusión. La alternancia prolongada hambre-saciedad indujo en eSMT desaceleración de su metabolopatía mientras que la realimentación se asoció con incrementos superiores de peso y glucemia, atribuibles a un aumento de la eficiencia de conversión inducida por el ayuno. Estos resultados enfatizan la importancia de mejorar el conocimiento sobre las relaciones entre crecimiento, alimentación y diabetes.

  8. Usefulness of Magnifying Endoscopy with Narrow-Band Imaging for Determining Tumor Invasion Depth in Early Gastric Cancer

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    Daisuke Kikuchi

    2013-01-01

    Full Text Available Backgrounds. Magnifying endoscopy with narrow-band imaging (ME-NBI has become essential for determining tumor margin in early gastric cancer (EGC. Here, we investigated the usefulness of ME-NBI for assessment of invasion depth in EGC. Methods. For 119 patients who had undergone ME-NBI and en bloc resection by endoscopic submucosal dissection, three physicians prospectively examined high-magnification ME-NBI images for clinical features such as presence or absence of dilated vessels (D vessels. Cases with D vessels verified by at least two physicians were assigned to group V, and others were assigned to group N. We then compared clinicopathological factors associated with the groups. Results. Groups V and N consisted of 18 and 101 patients, respectively. There were no significant differences in age, gender, tumor size, tumor location, gross morphology, or histological type. The percentage of submucosal cancer was 9.9% (10/101 in group N and significantly higher at 33.3% (6/18 in group V (. When the presence of D vessels was considered a diagnostic criterion for submucosal cancer, diagnostic accuracy, sensitivity, and specificity were 81.5, 37.5, and 88.3%, respectively. Conclusions. The results suggest that identification of D vessels using ME-NBI can assist in the assessment of invasion depth in EGC.

  9. Report of two cases of granular cell tumor, a rare tumor in children

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    Tuğçe Yasak

    2016-11-01

    Full Text Available Granular cell tumor (GCT is a rare soft tissue neoplasm. It was first named as “granular cell myoblastoma” in 1926 by Abrikossof. GCT often manifests as a single, painless nodule that shows a slow enlargement in the cutaneous, subcutaneous, or submucosal tissues. It mostly affects adults between ages 30 and 60 years, and is very rare in children. We herein report two children with GCT; the first patient with a tumor in the neck is presented due to the rare occurrence of the tumor in children. The other patient with a tumor in the leg is presented both due to the rare occurrence of the tumor in children and the relatively less common site of occurrence. Both of the patients were female. The mean tumor size was 2.5 × 2 cm. Histopathological examination of the specimens revealed benign granular cell tumor. One of the patients who had positive margin did not follow-up after the first excision of the tumor and she presented with a local recurrence in a year. Then a wide excision was performed and the defect was closed primarily. The second patient had negative margin and had no recurrence during the follow-up period. Granular cell tumor is rare in children. Although it is mostly benign, it may be malignant in approximately 2% of the cases and metastasize. The local recurrence in a year is characteristic for malignant GCT before metastasis. Positive surgical margins are associated with high recurrence rates, therefore total excision of the tumor is crucial for local recurrence. GCT should be included in the differential diagnosis of head and neck masses. It should be remembered that the tumor may arise in atypical locations and there is a possibility of malignancy.

  10. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia.

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    Terheggen, Grischa; Horn, Eva Maria; Vieth, Michael; Gabbert, Helmut; Enderle, Markus; Neugebauer, Alexander; Schumacher, Brigitte; Neuhaus, Horst

    2017-05-01

    For endoscopic resection of early GI neoplasia, endoscopic submucosal dissection (ESD) achieves higher rates of complete resection (R0) than endoscopic mucosal resection (EMR). However, ESD is technically more difficult and evidence from randomised trial is missing. We compared the efficacy and safety of ESD and EMR in patients with neoplastic Barrett's oesophagus (BO). BO patients with a focal lesion of high-grade intraepithelial neoplasia (HGIN) or early adenocarcinoma (EAC) ≤3 cm were randomised to either ESD or EMR. Primary outcome was R0 resection; secondary outcomes were complete remission from neoplasia, recurrences and adverse events (AEs). There were no significant differences in patient and lesion characteristics between the groups randomised to ESD (n=20) or EMR (n=20). Histology of the resected specimen showed HGIN or EAC in all but six cases. Although R0 resection defined as margins free of HGIN/EAC was achieved more frequently with ESD (10/17 vs 2/17, p=0.01), there was no difference in complete remission from neoplasia at 3 months (ESD 15/16 vs EMR 16/17, p=1.0). During a mean follow-up period of 23.1±6.4 months, recurrent EAC was observed in one case in the ESD group. Elective surgery was performed in four and three cases after ESD and EMR, respectively (p=1.0). Two severe AEs were recorded for ESD and none for EMR (p=0.49). In terms of need for surgery, neoplasia remission and recurrence, ESD and EMR are both highly effective for endoscopic resection of early BO neoplasia. ESD achieves a higher R0 resection rate, but for most BO patients this bears little clinical relevance. ESD is, however, more time consuming and may cause severe AE. NCT1871636. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Randomized comparative evaluation of endoscopic submucosal dissection self-learning software in France and Japan.

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    Pioche, Mathieu; Rivory, Jérôme; Nishizawa, Toshihiro; Uraoka, Toshio; Touzet, Sandrine; O'Brien, Marc; Saurin, Jean-Christophe; Ponchon, Thierry; Denis, Angélique; Yahagi, Naohisa

    2016-12-01

    Background and study aim: Endoscopic submucosal dissection (ESD) is currently the reference method to achieve an en bloc resection for large lesions; however, the technique is difficult and risky, with a long learning curve. In order to reduce the morbidity, training courses that use animal models are recommended. Recently, self-learning software has been developed to assist students in their training. The aim of this study was to evaluate the impact of this tool on the ESD learning curve. Methods: A prospective, randomized, comparative study enrolled 39 students who were experienced in interventional endoscopy. Each student was randomized to one of two groups and performed 30 ESDs of 30 mm standardized lesions in a bovine colon model. The software group used the self-learning software whereas the control group only observed an ESD procedure video. The primary outcome was the rate of successful ESD procedures, defined as complete en bloc resection without any perforation and performed in less than 75 minutes. Results: A total of 39 students performed 1170 ESDs. Success was achieved in 404 (70.9 %) in the software group and 367 (61.2 %) in the control group (P = 0.03). Among the successful procedures, there were no significant differences between the software and control groups in terms of perforation rate (22 [4.0 %] vs. 29 [5.1 %], respectively; P = 0.27) and mean (SD) procedure duration (34.1 [13.4] vs. 32.3 [14.0] minutes, respectively; P = 0.52). For the 30th procedure, the rate of complete resection was superior in the software group (84.2 %) compared with the control group (50.0 %; P = 0.01). Conclusion: ESD self-learning software was effective in improving the quality of resection compared with a standard teaching method using procedure videos. This result suggests the benefit of incorporating such software into teaching programs. © Georg Thieme Verlag KG Stuttgart · New York.

  12. The submucosal cushion does not improve the histologic evaluation of adenomatous colon polyps resected by snare polypectomy.

    Science.gov (United States)

    Jovanovic, Ivan; Caro, Carlos; Neumann, Helmut; Lux, Anke; Kuester, Doerthe; Fry, Lucia C; Malfertheiner, Peter; Mönkemüller, Klaus

    2011-10-01

    Although the "submucosal cushion" technique or injection-assisted polypectomy (IAP) is often used to resect colon polyps, little is known on the influence of this technique on histologic interpretation. We aimed to evaluate whether the use of a submucosal cushion improves the histologic and margin evaluation of colon polyps. Consecutive patients undergoing polypectomy with and without IAP were included. An experienced blinded gastrointestinal pathologist evaluated the specimens using standardized criteria. One hundred eleven sessile colon adenomas were analyzed (IAP, n = 65, standard, n = 46). Two-thirds of polyps ranged in size from 10 to 20 mm; the average polyp size was 13.2 mm for IAP and 9.9 mm for standard snare polypectomy (P = .001). The cautery degree, cautery amount, and margin evaluability, did not differ substantially with regard to the resection technique. For polyps ≥10-20 mm, the overall architecture quality was better in polyps resected with standard technique as compared with IAP. The utilization of IAP did not result in a better margin evaluability of the resected polyp. Overall, IAP does not result in a better histologic polyp evaluability. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

  13. Endoscopic muscularis excavation for subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer.

    Science.gov (United States)

    Zhang, Yu; Ye, Li-ping; Zhu, Lin-hong; Zhou, Xian-bin; Mao, Xin-li; Ding, Jin-xiu

    2013-05-01

    Because of complicating anatomic factors, endoscopic submucosal dissection is seldom performed in subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer. This study was designed to evaluate the feasibility of endoscopic muscularis excavation for treating subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer. Between December 2008 and December 2011, 68 patients with subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer were treated with endoscopic muscularis excavation. Key steps of the procedure included the following: (1) injecting a mixture solution into the submucosal layer after making several dots around the tumor; (2) making a cross incision of the overlying mucosa, and excavating the tumor from the muscularis propria layer; (3) closing the artificial ulcer with clips after tumor removal. The mean tumor size was 16.2 mm (range 7-35 mm). Endoscopic muscularis excavation was successfully performed in 65 out of 68 cases (success rate 95.6 %). Pathological diagnosis of these tumors included leiomyoma (39 out of 68) and gastrointestinal stromal tumor (29 out of 68). Perforation occurred in seven patients (10.3 %). No massive bleeding or delayed bleeding occurred. The median follow-up period after the procedure was 23 months (range 6-42 months). No residual or recurrent tumor was detected and no stricture occurred in patients during the follow-up period. Endoscopic muscularis excavation is a safe, effective and feasible procedure for providing accurate histopathologic evaluation and curative treatment for subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer.

  14. Spinal tumor

    Science.gov (United States)

    Tumor - spinal cord ... tissue) Myeloma (blood cancer that starts in the plasma cells of the bone marrow) A small number of spinal tumors occur in the nerves of the spinal cord itself. Tumors that start in spinal tissue are ...

  15. Wilms Tumor

    Science.gov (United States)

    Wilms tumor is a rare type of kidney cancer. It causes a tumor on one or both kidneys. It usually affects ... are at risk should be screened for Wilms tumor every three months until they turn eight. Symptoms ...

  16. Preservation of the endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound ablation of submucosal uterine fibroids.

    Science.gov (United States)

    Kim, Young-Sun; Kim, Tae-Joong; Lim, Hyo Keun; Rhim, Hyunchul; Jung, Sin-Ho; Ahn, Joong Hyun; Lee, Jeong-Won; Kim, Byoung-Gie

    2017-09-01

    To evaluate the integrity of endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of submucosal uterine fibroids based on contrast-enhanced MRI findings, and to identify the risk factors for endometrial impairment. In total, 117 submucosal fibroids (diameter: 5.9 ± 3.0 cm) in 101 women (age: 43.6 ± 4.4 years) treated with MR-HIFU ablation were retrospectively analysed. Endometrial integrity was assessed with contrast-enhanced T1-weighted images at immediate (n = 101), 3-month (n = 62) and 12-month (n = 15) follow-ups. Endometrial impairment was classified into grades 0 (continuous endometrium), 1 (pin-point, full-thickness discontinuity), 2 (between grade 1 and 3), or 3 (full-thickness discontinuity >1 cm). Risk factors were assessed with generalized estimating equation (GEE) analysis. Among 117 fibroids, grades 0, 1, 2 and 3 endometrial impairments were observed at initial examination in 56.4%, 24.8%, 13.7% and 4.3%, respectively. Among 37 fibroid cases of endometrial impairment for which follow-ups were conducted, 30 showed improvements at 3- and/or 12-month follow-up. GEE analysis revealed the degree of endometrial protrusion was significantly associated with severity of endometrial injury (P HIFU ablation of submucosal fibroids, endometrial enhancement was preserved intact or minimally impaired in most cases. Impaired endometrium, which is more common after treating endometrially-protruded fibroids, may recover spontaneously. • After MR-HIFU ablation for submucosal fibroid, endometrium is mostly preserved/minimally impaired. • Endometrial-protruded submucosal fibroid is susceptible to more severe endometrial impairment. • The impaired endometrium may recover spontaneously at follow-up MR exams.

  17. A Gastrointestinal Stromal Tumor of the Stomach Demonstrating a Stepwise Progression from Low- to High-Grade Malignancy

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    Takahiko Nakajima

    2012-01-01

    Full Text Available We report a case of a gastrointestinal stromal tumor (GIST of the stomach that demonstrated a stepwise progression from low- to high-grade malignancy. The patient had been followed for a small gastric submucosal tumor that had turned malignant after 8 years of indolence, manifested by tarry stools. The tumor was enucleated, and gastric GIST was diagnosed. The most significant histological finding was that the tumor comprised two clearly demarcated areas, one with less aggressive characteristics and the other with highly aggressive characteristics. The patient exhibited multiple liver metastases 24 months after surgery. Imatinib mesylate was not administered throughout the clinical course because it was not available for clinical use at that time. The patient followed an unfavorable clinical course and died of liver dysfunction 55 months after surgery. Autopsy was performed. By comparing the immunohistochemical profiles of primary and metastatic tumors, it was established that only the tumor cells with highly aggressive characteristics had metastasized.

  18. Robot assisted tumor resection devices.

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    Saito, Yutaka; Sumiyama, Kazuki; Chiu, Philip Wai-Yan

    2017-08-01

    In Japan, colorectal endoscopic submucosal dissection (ESD) is being conducted safely and effectively as shown by the increased number of the cases, however, it is still regarded as a complicated and challenging procedure. Therefore, piecemeal endoscopic mucosal resection (p-EMR) is still regarded as an appropriate treatment, rather than ESD for large colorectal tumors, especially in Western countries. Areas covered: There are several factors those are responsible for colorectal ESD difficulty. Firstly, there is no adequate traction or counter-traction in colorectal ESD. Secondly, it is challenging to handle the colonoscope in a redundant and narrow colonic lumen. Thirdly, the risk of perforation is estimated to be relatively higher compared to the stomach or esophagus Expert commentary: To overcome these difficulties, various traction and counter-traction methods have been reported and finally, the new concept of the Master and Slave Transluminal Endoscopic Robot (MASTER) has been developed and is soon to be available for clinical use. The authors have reviewed the history of colorectal ESD and MASTER in this paper.

  19. Moderate evidence to recommend submucosal injection of dexamethasone in reducing post-operative oedema and pain after third molar extraction.

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    Freda, Nicolas M; Keenan, Analia Veitz

    2016-06-01

    Data sourcesThe electronic databases searched included: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (Central) and Web of Science until June 2015. There was no restriction to language and the reference lists from relevant studies were searched for further articles.Study selectionRandomised and prospective controlled trials that compared the effect of submucosal injection of dexamethasone with that of placebo after impacted third molar surgery in humans. Studies involving volunteers with decompensated metabolic disease were excluded.Data extraction and synthesisStudy selection, data extraction and quality assessment (risk of bias) were assessed by two reviewers. All disagreements were resolved through discussion. A meta-analysis was performed for all continuous variables (oedema, pain and trismus) when at least two of the studies analysed the same data type.ResultsEight studies involving a total of 476 patients of which six were included in the meta-analysis. All of the surgical procedures were performed on the lower molars, submucosal injections of dexamethasone were used in concentrations of 4 mg, 8 mg, or 10 mg, and saline was used as a control. Antibiotic medications were administered prophylactically before surgery or by continuous use after the procedure. Seven of the eight studies identified the impactions according to the Pell and Gregory Classification. Oedema was measured using facial contours of pre-established reference points. The meta-analysis presented a mean difference (MD) of -2.20 (95% CI -2.70 to -1.70), with a statistically significant difference favouring dexamethasone (Pthird molar surgery. There was no significant difference, in regards to trismus, between placebo and dexamethasone.

  20. Analysis of opto-thermal interaction of porcine stomach tissue with 808-nm laser for endoscopic submucosal dissection

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    Seongjun Kim

    2015-11-01

    Full Text Available In endoscopic submucosal dissection (ESD, the narrow gastrointestinal space can cause difficulty in surgical interventions. Tissue ablation apparatuses with high-power CO2 lasers or Nd:YAG lasers have been developed to facilitate endoscopic surgical procedures. We studied the interaction of 808-nm laser light with a porcine stomach tissue, with the aim of developing a therapeutic medical device that can remove lesions at the gastrointestinal wall by irradiating a near-infrared laser light incorporated in an endoscopic system. The perforation depths at the porcine fillet and the stomach tissues linearly increased in the range of 2–8 mm in proportion to the laser energy density of 63.7–382 kJ/cm2. Despite the distinct structural and compositional difference, the variation of the perforation depth between the stomach and the fillet was not found at 808-nm wavelength in our measurement. We further studied the laser–tissue interaction by changing the concentration of the methyl blue solution used conventionally as a submucosal fluidic cushion (SFC in ESD procedures. The temperature of the mucosal layer increased more rapidly at higher concentration of the methyl blue solution, because of enhanced light absorption at the SFC layer. The insertion of the SFC would protect the muscle layer from thermal damage. We confirmed that more effective laser treatment should be enabled by tuning the opto-thermal properties of the SFC. This study can contribute to the optimization of the driving parameters for laser incision techniques as an alternative to conventional surgical interventions.

  1. Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos).

    Science.gov (United States)

    Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Harada, Masaru

    2015-02-01

    A 5-7 day hospital stay is usually needed after endoscopic submucosal dissection (ESD) of gastric tumor because of the possibility of delayed perforation or bleeding. The aim of this study was to evaluate the efficacy of combined use of a single over-the-scope clip (OTSC) and through-the-scope clips (TTSCs) to achieve complete closure of artificial gastric ulcer after ESD. We prospectively studied 12 patients with early gastric cancer or gastric adenoma. We performed complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs. Mean size of post-ESD artificial ulcer was 54.6 mm. The mean operating time for the closure procedure was 15.2 min., and the success rate was 91.7 % (11/12). Patients who underwent complete closure of post-ESD artificial gastric ulcer could be discharged the day after ESD and the closing procedure. Complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs is useful for shortening the period of hospitalization and reducing treatment cost.

  2. Tumor Budding Is Independently Predictive for Lymph Node Involvement in Early Gastric Cancer.

    Science.gov (United States)

    Gulluoglu, Mine; Yegen, Gulcin; Ozluk, Yasemin; Keskin, Metin; Dogan, Serap; Gundogdu, Gökçen; Onder, Semen; Balik, Emre

    2015-08-01

    The most important prognostic factor for early gastric cancer (EGC) is the lymph node status. It is important to predict early lesions without lymph node metastasis (LNM) before proceeding to radical surgery in locally excised lesions. Tumor budding is a feature known to be related to aggressive tumor behavior in several solid tumors. We aimed to assess the predictive value of tumor budding for LNM in pT1a and pT1b gastric cancer. We retrospectively investigated radical gastrectomy specimens for of 126 EGC patients and assess the possible relation between the clinicopathologic features, including age, gender, tumor location, tumor size, macroscopic tumor type, histologic differentiation, depth and width of submucosal invasion, lymphovascular invasion, and tumor budding with lymph node involvement. Among the 126 EGCs, 38 were stages as pT1a and 88 as pT1b. LNM rate in pT1a tumors was 13% whereas it was 33% in pT1b tumors. Tumor budding was the only factor significantly and independently related to LNM in pT1a patients. Female gender and tumor budding were found to be independent risk factors in pT1b group. Other clinicopathologic features were not related to LNM. Based on these results, we suggest that budding is a promising parameter to assess for prediction of LNM in EGC removed by endoscopic surgery, and to decide on the appropriate surgical approach. © The Author(s) 2015.

  3. Successful mucosal incision-assisted biopsy for the histological diagnosis of duodenal lymphoma: A case report

    Science.gov (United States)

    MORISHITA, ASAHIRO; MORI, HIROHITO; KOBARA, HIDEKI; NISHIYAMA, NORIKO; FUJIHARA, SHINTARO; YACHIDA, TATSUO; AYAKI, MAKI; MATSUNAGA, TAE; SAKAMOTO, TEPPEI; MAEDA, EMIKO; NOMURA, TAKAKO; TANI, JOJI; MIYOSHI, HISAAKI; YONEYAMA, HIROHITO; HIMOTO, TAKASHI; KAGAWA, SEIKO; HABA, REIJI; MASAKI, TSUTOMU

    2016-01-01

    Tissue sampling of primary duodenal lymphoma is essential for its histological diagnosis. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), which is frequently used for submucosal tumor (SMT)-like duodenal tumors, is adequate for cytological diagnosis, but not for histological diagnosis. Therefore, in the present study, a mucosal incision-assisted biopsy (MIAB) was performed in an 81-year-old woman for the diagnosis of an SMT-like duodenal mass, as tissue sampling for histological analysis using a regular endoscopic biopsy had failed to establish a definite diagnosis of malignant lymphoma. EUS-FNA had also led to poor tissue sampling due to the difficult location of the duodenal tumor. The pathological examination of biopsy samples using MIAB revealed the presence of a diffuse proliferation of atypical lymphocytes, and the expression of cluster of differentiation (CD)20 and CD79a, but no expression of CD3 in the tumor specimens. The patient was diagnosed with diffuse large B-cell lymphoma. To the best of knowledge, this is first report of a case using MIAB as a sampling method for the histological diagnosis of SMT-like primary duodenal lymphoma. This case suggests that MIAB may be an essential method for obtaining tissue samples from SMT-like duodenal tumors. PMID:26870243

  4. Gastric Schwannoma Mimicking Malignant Gastrointestinal Stromal Tumor Exhibiting Increased Fluorodeoxyglucose Uptake.

    Science.gov (United States)

    Oh, Sung Jin; Suh, Byoung Jo; Park, Jong Kwon

    2016-01-01

    A schwannoma is a kind of neurogenic tumor that rarely occurs in the gastrointestinal tract. Gastric schwannomas make up 0.2% of all gastric neoplasms. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors and up to 60-70% of GIST occur in the stomach. Schwannoma and GIST are similar in clinical features, so they are difficult to differentiate preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST and the relatively benign course of gastric schwannomas. We report a 49-year-old woman who was diagnosed after operation with a gastric schwannoma, which was suspected a malignant GIST by fluorine-18-fluorodeoxyglucose positron emission computed tomography imaging.

  5. Gastric Schwannoma Mimicking Malignant Gastrointestinal Stromal Tumor Exhibiting Increased Fluorodeoxyglucose Uptake

    Directory of Open Access Journals (Sweden)

    Sung Jin Oh

    2016-04-01

    Full Text Available A schwannoma is a kind of neurogenic tumor that rarely occurs in the gastrointestinal tract. Gastric schwannomas make up 0.2% of all gastric neoplasms. Gastrointestinal stromal tumors (GIST are the most common mesenchymal tumors and up to 60-70% of GIST occur in the stomach. Schwannoma and GIST are similar in clinical features, so they are difficult to differentiate preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST and the relatively benign course of gastric schwannomas. We report a 49-year-old woman who was diagnosed after operation with a gastric schwannoma, which was suspected a malignant GIST by fluorine-18-fluorodeoxyglucose positron emission computed tomography imaging.

  6. Hypothalamic tumor

    Science.gov (United States)

    Hypothalamic glioma; Hypothalamus - tumor ... The exact cause of hypothalamic tumors is not known. It is likely that they result from a combination of genetic and environmental factors. In children, ...

  7. Clinical and Endoscopic Features of Metastatic Tumors in the Stomach

    Science.gov (United States)

    Kim, Ga Hee; Ahn, Ji Yong; Jung, Hwoon-Yong; Park, Young Soo; Kim, Min-Ju; Choi, Kee Don; Lee, Jeong Hoon; Choi, Kwi-Sook; Kim, Do Hoon; Lim, Hyun; Song, Ho June; Lee, Gin Hyug; Kim, Jin-Ho

    2015-01-01

    Background/Aims Metastasis to the stomach is rare. The aim of this study was to describe and analyze the clinical outcomes of cancers that metastasized to the stomach. Methods We reviewed the clinicopathological aspects of patients with gastric metastases from solid organ tumors. Thirty-seven cases were identified, and we evaluated the histology, initial presentation, imaging findings, lesion locations, treatment courses, and overall patient survival. Results Endoscopic findings indicated that solitary lesions presented more frequently than multiple lesions and submucosal tumor-like tumors were the most common appearance. Malignant melanoma was the tumor that most frequently metastasized to the stomach. Twelve patients received treatments after the diagnosis of gastric metastasis. The median survival period from the diagnosis of gastric metastasis was 3.0 months (interquartile range, 1.0 to 11.0 months). Patients with solitary lesions and patients who received any treatments survived longer after the diagnosis of metastatic cancer than patients with multiple lesions and patients who did not any receive any treatments. Conclusions Proper treatment with careful consideration of the primary tumor characteristics can increase the survival period in patients with tumors that metastasize to the stomach, especially in cases with solitary metastatic lesions in endoscopic findings. PMID:25473071

  8. Brief Education on Microvasculature and Pit Pattern for Trainees Significantly Improves Estimation of the Invasion Depth of Colorectal Tumors

    Directory of Open Access Journals (Sweden)

    Joon Sung Kim

    2014-01-01

    Full Text Available Objectives. This study was performed to evaluate the effectiveness of education for trainees on the gross findings identified by conventional white-light endoscopy (CWE, the microvascular patterns identified by magnifying narrow-band imaging endoscopy (MNE, and the pit patterns identified by magnifying chromoendoscopy (MCE in estimation of the invasion depth of colorectal tumors. Methods. A total of 420 endoscopic images of 35 colorectal tumors were used. Five trainees estimated the invasion depth of the tumors by reviewing the CWE images before education. Afterwards, the trainees estimated the invasion depth of the same tumors after brief education on CWE, MNE and MCE images, respectively. Results. The initial diagnostic accuracy for deep submucosal invasion before education and after education on CWE, MNE, and MCE findings was 54.3%, 55.4%, 67.4%, and 76.6%, respectively. The diagnostic accuracy increased significantly after MNE education (P=0.028. The specificity for deep submucosal invasion before education and after education on CWE, MNE, and MCE findings was 47.9%, 45.7%, 65.0%, and 80.7%, respectively. The specificity increased significantly after MNE (P=0.002 and MCE (P=0.005 education. Conclusion. Brief education on microvascular pattern identification by MNE and pit pattern identification by MCE significantly improves trainees’ estimations of the invasion depth of colorectal tumors.

  9. Low-Grade Uterine Epithelioid Hemangioendothelioma Presented as a Submucosal Leiomyoma during Labor

    Directory of Open Access Journals (Sweden)

    Anastasios V. Koutsopoulos

    2013-01-01

    Full Text Available With the exception of leiomyomas, soft tissue tumors of the uterine corpus are not common. This is particularly true for vascular neoplasms, with the epithelioid hemangioendothelioma being a curiosity; not more than twenty-two cases of malignant hemangioendotheliomas have been reported in the literature so far, all of which were high-grade hemangioendotheliomas (hemangiosarcomas. We present herewith a unique case of low-grade epithelioid hemangioendothelioma of the uterus in a pregnant woman aged 29 years. The clinical, histological, and immunohistochemical characteristics of this entity, together with its differential diagnosis, are discussed.

  10. Endoscopic Full-Thickness Resection of a Colonic Lateral Spreading Tumor.

    Science.gov (United States)

    Bucalau, Ana-Maria; Lemmers, Arnaud; Arvanitakis, Marianna; Blero, Daniel; Neuhaus, Horst

    2018-01-17

    The Full-Thickness Resection Device (FTRD; Ovesco Endoscopy, Tübingen, Germany) combines endoscopic full-thickness resection (EFTR) of gastrointestinal lesions with closure and cutting of the tissue in one integrated procedure. It provides en-bloc resection with an integral wall specimen for histopathological evaluation. This resection technique is partially filling of the gaps between the current procedures of choice in endoscopy (endoscopic mucosal resection and endoscopic submucosal dissection) and surgery. We present the case of an EFTR procedure performed for a periappendicular lateral spreading tumor. © 2018 S. Karger AG, Basel.

  11. Multifocal gastrointestinal stromal tumor (GIST) of the stomach in an 11-year-old girl

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin [University of North Carolina Hospitals, Department of Radiology, Chapel Hill, NC (United States); Rubinas, Tara C. [University of North Carolina Hospitals, Department of Pathology, Chapel Hill, NC (United States); Fordham, Lynn A. [University of North Carolina School of Medicine, Department of Radiology, Chapel Hill, NC (United States); Phillips, J.D. [University of North Carolina School of Medicine, Department of Surgery, Division of Pediatric Surgery, Chapel Hill, NC (United States)

    2006-11-15

    A previously healthy 11-year-old girl presented with an 8-month history of anemia and left upper quadrant abdominal pain. US examination demonstrated a 9-cm cystic mass with a fluid-fluid level in the left upper quadrant with unclear organ of origin. Abdominal MR imaging demonstrated a complex cystic mass, likely arising from the stomach. Additional T2 hyperintense submucosal lesions were identified in the gastric wall. Surgical excision confirmed the diagnosis of multifocal gastric gastrointestinal stromal tumor (GIST). MR imaging was helpful in suggesting a gastric origin of the primary mass and in demonstrating multifocal disease within the stomach. (orig.)

  12. Brain Tumors

    Science.gov (United States)

    A brain tumor is a growth of abnormal cells in the tissues of the brain. Brain tumors can be benign, with no cancer cells, ... cancer cells that grow quickly. Some are primary brain tumors, which start in the brain. Others are ...

  13. Odontogenic Tumors

    OpenAIRE

    TAHSİNOĞLU, Melih

    2013-01-01

    DefinitionThe neoplasms that consist of the cells considered specialized for odontogenesis, and their product (dentin, enamel, cementum) are called odontogenic tumors.ClassificationTo initiate odontogenesis, epithelium is a must. Same rule holds for the odontogenic tumors: without odontogenic epithelium, odontogenic tumors cannot be, without the induction of odontogenic epithelium odontogenic mesenchyme cannot develop.

  14. Urogenital tumors

    Energy Technology Data Exchange (ETDEWEB)

    Weller, R.E.

    1994-03-01

    An overview is provided for veterinary care of urogenital tumors in companion animals, especially the dog. Neoplasms discussed include tumors of the kidney, urinary bladder, prostate, testis, ovary, vagina, vulva and the canine transmissible venereal tumor. Topics addressed include description, diagnosis and treatment.

  15. Status of the Gastric Mucosa with Endoscopically Diagnosed Gastrointestinal Stromal Tumor

    Directory of Open Access Journals (Sweden)

    Kouichi Nonaka

    2014-01-01

    Full Text Available Background. Since gastrointestinal stromal tumor (GIST is a mesenchymal submucosal tumor, the endosonographic, CT, and MRI features of gastric GISTs have been widely investigated. However, the GIST-bearing gastric mucosa status has not been reported. Objective. To characterize the GIST-bearing gastric mucosa status in terms of the degree of inflammation and atrophy, assessed endoscopically. Subjects and Methods. The subjects were 46 patients with submucosal tumors (histologically proven gastric GISTs who had undergone upper gastrointestinal endoscopy in our hospital between April 2007 and September 2012. They were retrospectively evaluated regarding clinicopathological features, the endoscopically determined status of the entire gastric mucosa (presence or absence and degree of atrophy, presence or absence and severity of endoscopic gastritis/atrophy (A-B classification at the GIST site, and presence or absence of H. pylori infection. Results. Twenty-three patients had no mucosal atrophy, but 17 and 6 had closed- and open-type atrophy, respectively. Twenty-six, 5, 12, 1, 1, and 1 patients had grades B0, B1, B2, B3, A0, and A1 gastritis/atrophy at the lesion site, respectively, with no grade A2 gastritis/atrophy. Conclusion. The results suggest that gastric GISTs tend to arise in the stomach wall with H. pylori-negative, nonatrophic mucosa or H. pylori-positive, mildly atrophic mucosa.

  16. Neuroendocrine Tumors in the Stomach, Duodenum, and Pancreas Accompanied by Novel MEN1 Gene Mutation.

    Science.gov (United States)

    Yang, Min A; Lee, Woong Ki; Shin, Hong Shik; Park, Sung Hyun; Kim, Byung Sun; Kim, Ji Woong; Cho, Jin Woong; Yun, So Hee

    2017-03-25

    Multiple endocrine neoplasia type 1 (MEN1) syndrome is a relatively rare disease, characterized by the occurrence of multiple endocrine tumors in the parathyroid and pituitary glands as well as the pancreas. Here, we report a case of MEN1 with neuroendocrine tumors (NETs) in the stomach, duodenum, and pancreas. A 53-year-old man visited our hospital to manage gastric NET. Five years prior to his visit, he had undergone surgery for incidental meningioma. His brother had pancreatic nodules and a history of surgery for adrenal adenoma. His brother's daughter also had pancreatic nodules, but had not undergone surgery. The lesion was treated by endoscopic submucosal dissection and diagnosed as a grade 1 NET. Another small NET was detected in the second duodenal portion, resected by endoscopic submucosal dissection, which was also diagnosed as a grade 1 NET. During evaluation, three nodules were detected in the pancreas, and no evidence of pituitary, parathyroid tumors, or metastasis was observed. After surgery, the pancreatic lesions were diagnosed as NETs, with the same immunohistochemical patterns as those of the stomach and duodenum. Genetic testing was performed, and a heterozygous mutation was detected in the MEN1 gene, which is located on 11q13.

  17. Endoluminal surgical triangulation 2.0: A new flexible surgical robot. Preliminary pre-clinical results with colonic submucosal dissection.

    Science.gov (United States)

    Légner, András; Diana, Michele; Halvax, Péter; Liu, Yu-Yin; Zorn, Lucile; Zanne, Philippe; Nageotte, Florent; De Mathelin, Michel; Dallemagne, Bernard; Marescaux, Jacques

    2017-09-01

    Complex intraluminal surgical interventions of the gastrointestinal tract are challenging due to the limitation of existing instruments. Our group has developed a master-slave robotic flexible endoscopic platform that provides instrument triangulation in an endoluminal environment. Colonic endoscopic submucosal dissections (ESD) were carried out in eight pigs. The robot was introduced transanally. A combination of adapted tele-operated instruments was used. Specimens were inspected and measured. Out of 18 ESDs in total, 12 were successfully completed. Among the completed procedures, two perforations and one system failure occurred and were managed intraoperatively. There was no major bleeding. Mean size of the removed specimens was 18.2 ± 9.8 cm(2) and mean total procedure time was 73 ± 35.5 min. Experimental colorectal ESDs using the flexible surgical robot were feasible and reflected a short learning curve. After some technical improvements the system might allow for a wider adoption of complex endoluminal surgical procedures. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Two-week treatment with proton pump inhibitor is sufficient for healing post endoscopic submucosal dissection ulcers

    Science.gov (United States)

    Arai, Makoto; Matsumura, Tomoaki; Okimoto, Kenichiro; Oyamada, Arata; Saito, Keiko; Minemura, Shoko; Maruoka, Daisuke; Tanaka, Takeshi; Nakagawa, Tomoo; Katsuno, Tatsuro; Yokosuka, Osamu

    2014-01-01

    AIM: To investigate the optimum period of treatment for post endoscopic submucosal dissection (ESD) ulcers. METHODS: Patients who underwent ESD for gastric cancer were randomized to two groups and treated with esomeprazole 20 mg per day for 4 wk (4W group) or 2 wk (2W group). At 4 wk after ESD, we measured the size of the artificial ulcers by endoscopy and determined the ulcer healing rate, compared with the size of the ESD specimens. This randomized controlled trial study was approved by our ethics committee and registered in the UMIN Clinical Trial Registry. RESULTS: A total of 60 consecutive patients were included in the study. All patients received rebamipide 300 mg per day for 4 wk. One patient in 2W group who showed bleeding within two weeks and received endoscopic treatment was excluded from further analysis. The numbers of patients with ulcers in the healing/scar stage in the 2W and 4W groups at 4 wk after ESD were 20/6 and 28/5, respectively, with no significant difference. The ulcer healing rate in the 2W and 4W groups were 96.1% [95% confidence interval (CI): 94.6%-97.55] vs 94.8% (95%CI: 92.6%-97.1%), respectively, with no statistical difference (UMIN000006951). CONCLUSION: Two-wk treatment with a proton pump inhibitor is as effective as four-week treatment for healing post ESD ulcers. PMID:25473190

  19. Cost comparison between surgical treatments and endoscopic submucosal dissection in patients with early gastric cancer in Korea.

    Science.gov (United States)

    Kim, Younhee; Kim, Young Woo; Choi, Il Ju; Cho, Joo Young; Kim, Jong Hee; Kwon, Jin Won; Lee, Ja Youn; Lee, Na Rae; Seol, Sang Yong

    2015-03-01

    This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surger-ies in patients with early gastric cancer (EGC). Pa-tients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the ex-penses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surger-ies. ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications. (Gut Liver, 2015;9174-180).

  20. Frozen Section Biopsy to Evaluation of Obscure Lateral Resection Margins during Gastric Endoscopic Submucosal Dissection for Early Gastric Cancer

    Science.gov (United States)

    Kang, Eun Jung; Lee, Tae Hee; Jin, So Young; Cho, Won Young; Bok, Jin Hyun; Kim, Hyun Gun; Kim, Jin Oh; Lee, Joon Seong; Lee, Il Hyun

    2011-01-01

    Purpose To determine the diagnostic utility of a frozen section biopsy in patients undergoing endoscopic submucosal dissection (ESD) for early gastric neoplasms with obscure margins even with chromoendoscopy using acetic acid and indigo carmine (AI chromoendoscopy). Materials and Methods The lateral spread of early gastric neoplasms was unclear even following AI chromoendoscopy in 38 patients who underwent ESD between June 2007 and May 2011. Frozen section biopsies were obtained by agreement of the degree of lateral spread between two endoscopists. Thus, frozen section biopsies were obtained from 23 patients (FBx group) and not in the other 15 patients (AI group). Results No significant differences were observed for size, histology, invasive depth, and location of lesions between the AI and FBx groups. No false positive or false negative results were observed in the frozen section diagnoses. Adenocarcinoma was revealed in three patients and tubular adenoma in one, thereby changing the delineation of lesion extent and achieving free lateral margins. The rates of free lateral resection margins and curative resection were significantly higher in the FBx group than those in the AI group. Conclusions Frozen section biopsy can help endoscopists perform more safe and accurate ESD in patients with early gastric neoplasm. PMID:22076220

  1. Gastrointestinal stromal tumor of the stomach with lymph node metastasis

    Directory of Open Access Journals (Sweden)

    Nalbant Olcay

    2008-09-01

    Full Text Available Abstract Background Lymph node (LN metastasis of gastrointestinal stromal tumors (GIST is unusual. Unlike gastric adenocarcinomas, routine lymphadenectomy is not recommended unless there is no suspicion for LN metastasis. Herein, we report a case of GIST of the stomach with LN metastasis treated with distal gastrectomy with perigastric LN dissection followed by adjuvant imatinib therapy. Case presentation A 32-year-old female presented with anemia. Diagnostic investigations including thoracoabdominopelvic computed tomography (CT scan and gastroscopy revealed a 8 cm gastric antral submucosal tumor without any metastasis. Enlarged periantral LNs were detected during laparotomy and patient underwent distal gastrectomy with en bloc perigastric LN dissection. Pathologic investigation revealed antral stromal tumor with high mitotic and Ki-67 index. Lymph node metastasis was observed in 7 of 12 resected perigastirc nodes. Immunohistochemically, tumor cells were positive for CD117. She was diagnosed as high grade gastric GIST due to the presence of LN metastasis, large tumor size and unfavorable histopathologic features thus underwent adjuvant imatinib treatment (400 mg, daily. No recurrence or metastasis has been detected during a 12-month of postoperative follow-up. Conclusion Surgery remains the mainstay of treatment in patients with localized, resectable GISTs. Although lymphatic metastasis rarely occurs in patients with GIST, LN dissection should be considered for patients with any suspicion of nodal metastasis. Adjuvant imatinib treatment is recommended according to the well defined prognostic factors.

  2. Gastrointestinal stromal tumor of the stomach with lymph node metastasis.

    Science.gov (United States)

    Canda, Aras Emre; Ozsoy, Yucel; Nalbant, Olcay Ak; Sagol, Ozgul

    2008-09-05

    Lymph node (LN) metastasis of gastrointestinal stromal tumors (GIST) is unusual. Unlike gastric adenocarcinomas, routine lymphadenectomy is not recommended unless there is no suspicion for LN metastasis. Herein, we report a case of GIST of the stomach with LN metastasis treated with distal gastrectomy with perigastric LN dissection followed by adjuvant imatinib therapy. A 32-year-old female presented with anemia. Diagnostic investigations including thoracoabdominopelvic computed tomography (CT) scan and gastroscopy revealed a 8 cm gastric antral submucosal tumor without any metastasis. Enlarged periantral LNs were detected during laparotomy and patient underwent distal gastrectomy with en bloc perigastric LN dissection. Pathologic investigation revealed antral stromal tumor with high mitotic and Ki-67 index. Lymph node metastasis was observed in 7 of 12 resected perigastirc nodes. Immunohistochemically, tumor cells were positive for CD117. She was diagnosed as high grade gastric GIST due to the presence of LN metastasis, large tumor size and unfavorable histopathologic features thus underwent adjuvant imatinib treatment (400 mg, daily). No recurrence or metastasis has been detected during a 12-month of postoperative follow-up. Surgery remains the mainstay of treatment in patients with localized, resectable GISTs. Although lymphatic metastasis rarely occurs in patients with GIST, LN dissection should be considered for patients with any suspicion of nodal metastasis. Adjuvant imatinib treatment is recommended according to the well defined prognostic factors.

  3. Odontogenic tumors.

    Science.gov (United States)

    Chrysomali, Evanthia; Leventis, Minas; Titsinides, Savas; Kyriakopoulos, Vasileios; Sklavounou, Alexandra

    2013-09-01

    This study aims to analyze the frequency and distribution of odontogenic tumors in a Greek population and compare the findings with those reported in the recent literature. Records of the Department of Oral Medicine and Pathology, Dental School, University of Athens, with histologic diagnosis of odontogenic tumors (based on the World Health Organization 2005 classification) were reviewed retrospectively from January 1970 to December 2011. A total of 652 cases of odontogenic tumors were reported. Of these, 651 (99.8%) were benign and only 1 (0.2%) was malignant. Keratocystic odontogenic tumor was the most frequent lesion (52.7%), followed by odontoma (18.9%) and ameloblastoma (16.1%). The mean age of patients was 38.0 years with a wide range (2.5-92 years). Odontogenic tumors are rare lesions and appear to show a definite geographic variation. In Athens, Greece, they are presented mainly by the keratocystic odontogenic tumor, odontoma, and ameloblastoma.

  4. Beyond the GIST: Mesenchymal Tumors of the Stomach

    Science.gov (United States)

    Menias, Christine O.; Gaballah, Ayman H.; Shroff, Stuti; Taggart, Melissa W.; Garg, Naveen; Elsayes, Khaled M.

    2013-01-01

    Intramural gastric masses arise in the wall of the stomach (generally within the submucosa or muscularis propria), often with intact overlying mucosa. These tumors are typically mesenchymal in origin and have overlapping radiologic appearances. A combination of features such as location, attenuation, enhancement, and growth pattern may suggest one diagnosis over another. Gastrointestinal stromal tumors (GISTs) account for the majority of intramural tumors and can vary widely in appearance, from small intraluminal lesions to exophytic masses that protrude into the peritoneal cavity, commonly with areas of hemorrhage or necrosis. A well-circumscribed mass measuring −70 to −120 HU is a lipoma. Leiomyomas usually manifest as low-attenuation masses at the gastric cardia. Homogeneous attenuation is a noteworthy characteristic of schwannomas, particularly for larger lesions that might otherwise be mistaken for GISTs. A hypervascular mass in the antrum is a common manifestation of glomus tumors. Hemangiomas are also hypervascular but often manifest in childhood. Inflammatory fibroid polyps usually arise as a polypoid mass in the antrum. Inflammatory myofibroblastic tumors are infiltrative neoplasms with a propensity for local recurrence. Plexiform fibromyxomas are rare, usually antral tumors. Carcinoid tumors are epithelial in origin, but often submucosal in location, and therefore should be distinguished from other intramural lesions. Multiple carcinoid tumors are associated with hypergastrinemia, either in the setting of chronic atrophic gastritis or Zollinger-Ellison syndrome. Sporadic solitary carcinoid tumors not associated with hypergastrinemia have a higher rate of metastasis. Histopathologic analysis, including immunohistochemistry, is usually required for diagnosis of intramural masses. © RSNA, 2013 PMID:24108557

  5. Pindborg tumor

    OpenAIRE

    Santhosh Kumar Caliaperoumal; Gowri, S.; J.Dinakar

    2016-01-01

    Calcifying epithelial odontogenic tumor (CEOT), also known as Pindborg tumor, is a rare odontogenic epithelial neoplasm. So far, nearly 200 cases have been reported in the literature. We are reporting a case of CEOT in a 42-year-old male patient with painless bony swelling in the mandible. The clinical, radiographic, and histopathologic features are discussed with relevant references.

  6. Pindborg tumor

    Directory of Open Access Journals (Sweden)

    Santhosh Kumar Caliaperoumal

    2016-01-01

    Full Text Available Calcifying epithelial odontogenic tumor (CEOT, also known as Pindborg tumor, is a rare odontogenic epithelial neoplasm. So far, nearly 200 cases have been reported in the literature. We are reporting a case of CEOT in a 42-year-old male patient with painless bony swelling in the mandible. The clinical, radiographic, and histopathologic features are discussed with relevant references.

  7. Pindborg tumor.

    Science.gov (United States)

    Caliaperoumal, Santhosh Kumar; Gowri, S; Dinakar, J

    2016-01-01

    Calcifying epithelial odontogenic tumor (CEOT), also known as Pindborg tumor, is a rare odontogenic epithelial neoplasm. So far, nearly 200 cases have been reported in the literature. We are reporting a case of CEOT in a 42-year-old male patient with painless bony swelling in the mandible. The clinical, radiographic, and histopathologic features are discussed with relevant references.

  8. Wilms Tumor

    Science.gov (United States)

    ... parts of the body; most commonly, the lungs, liver, bone, and/or brain. About 10% are stage IV. Stage V: Cancer is found in both kidneys at diagnosis (also called bilateral tumors). About 5% are stage V. Surgery is most often used to treat Wilms tumor. For stages I through IV, a ...

  9. Leydig cell tumor

    Science.gov (United States)

    Tumor - Leydig cell; Testicular tumor - Leydig; Testicular neoplasm ... The cause of this tumor is unknown. There are no known risk factors for this tumor. Unlike germ cell tumors of the testicles, this tumor ...

  10. Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection?

    Science.gov (United States)

    Nonaka, Takashi; Inamori, Masahiko; Miyashita, Tetsuya; Inoh, Yumi; Kanoshima, Kenji; Higurashi, Takuma; Ohkubo, Hidenori; Iida, Hiroshi; Fujita, Koji; Kusakabe, Akihiko; Gotoh, Takahisa; Nakajima, Atsushi

    2018-01-01

     The aim of this pilot randomized controlled trial was to evaluate and compare the satisfaction of the endoscopist along with the effectiveness and safety of sedation between sedation protocol using a combination of propofol (PF) and dexmedetomidine (DEX) (Combination group) and sedation protocol using PF alone (PF group) during gastric endoscopic submucosal dissection (ESD). Fifty-eight patients with gastric neoplasias scheduled for gastric ESD were enrolled and randomly assigned to the two groups. The satisfaction scores of the endoscopists and the parameters for the effectiveness and safety of sedation were evaluated by comparisons between the two groups. The satisfaction scores of the endoscopists, which were measured using a visual analogue scale, were significantly higher in the Combination group than in the PF group (88 vs. 69, P  = 0.003). The maintenance dose of PF was lower in the Combination group than in the PF group (2 mg/kg/h vs. 5 mg/kg/h, P  < 0.001), and the number of rescue PF injections was fewer in the Combination group than in the PF group (2 times vs. 6 times, P  < 0.001). The incidence of bradycardia (defined as a pulse rate ≤ 45 bpm) in the Combination group was higher than that in the PF group (37.9 % vs. 10.3 %, P  = 0.029). This study suggests that gastroenterologist-directed sedation using a combination of PF and DEX during gastric ESD can enhance the satisfaction levels of endoscopists by providing stable sedation with an acceptable safety profile.

  11. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia

    Science.gov (United States)

    Terheggen, Grischa; Horn, Eva Maria; Vieth, Michael; Gabbert, Helmut; Enderle, Markus; Neugebauer, Alexander; Schumacher, Brigitte; Neuhaus, Horst

    2017-01-01

    Background For endoscopic resection of early GI neoplasia, endoscopic submucosal dissection (ESD) achieves higher rates of complete resection (R0) than endoscopic mucosal resection (EMR). However, ESD is technically more difficult and evidence from randomised trial is missing. Objective We compared the efficacy and safety of ESD and EMR in patients with neoplastic Barrett's oesophagus (BO). Design BO patients with a focal lesion of high-grade intraepithelial neoplasia (HGIN) or early adenocarcinoma (EAC) ≤3 cm were randomised to either ESD or EMR. Primary outcome was R0 resection; secondary outcomes were complete remission from neoplasia, recurrences and adverse events (AEs). Results There were no significant differences in patient and lesion characteristics between the groups randomised to ESD (n=20) or EMR (n=20). Histology of the resected specimen showed HGIN or EAC in all but six cases. Although R0 resection defined as margins free of HGIN/EAC was achieved more frequently with ESD (10/17 vs 2/17, p=0.01), there was no difference in complete remission from neoplasia at 3 months (ESD 15/16 vs EMR 16/17, p=1.0). During a mean follow-up period of 23.1±6.4 months, recurrent EAC was observed in one case in the ESD group. Elective surgery was performed in four and three cases after ESD and EMR, respectively (p=1.0). Two severe AEs were recorded for ESD and none for EMR (p=0.49). Conclusions In terms of need for surgery, neoplasia remission and recurrence, ESD and EMR are both highly effective for endoscopic resection of early BO neoplasia. ESD achieves a higher R0 resection rate, but for most BO patients this bears little clinical relevance. ESD is, however, more time consuming and may cause severe AE. Trial registration number NCT1871636 PMID:26801885

  12. Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity.

    Science.gov (United States)

    Mori, H; Rafiq, K; Kobara, H; Fujihara, S; Nishiyama, N; Kobayashi, M; Himoto, T; Haba, R; Hagiike, M; Izuishi, K; Okano, K; Suzuki, Y; Masaki, T

    2012-07-01

    Endoscopic submucosal dissection (ESD) of large gastric lesions results in an extensive artificial ulcer that can lead to marked gastric deformity. The aim of the current study was to evaluate therapeutic efficacy in the prevention of gastric deformity of local triamcinolone acetonide (TCA) injection into the extensive artificial ulcer following ESD. A total of 45 patients who were diagnosed with early gastric cancer were enrolled. Patients were randomly assigned by the sealed-envelope randomization method to either local TCA injections (n = 21) or sham-control (n = 20) groups. Two clips were placed at the two maximum outer edges of the artificial ulcer after the lesion had been resected (Day 0). Local TCA injections were performed on postoperative Day 5 and Day 12. The distance between the two clips was measured by endoscopic measuring forceps on Days 5, 12, 30, and 60. Granulation formation and gastric deformity were evaluated by visual analog scale (VAS) on Days 30 and 60. Local TCA injection did not alter clip-to-clip distance on postoperative Day 60, and formation of flat granulation tissue over the ulcer was followed by regenerative mucosa without any gastric deformity. The sham-control group showed significant shortening of clip-to-clip distance compared with the local steroid-injected group and protruded forms of granulation tissue with mucosal convergence. Histological evaluation revealed prominent growth of neovessels, swelling, and marked increases in endothelial cells in the local steroid-injected group compared with the sham-control group. Local steroid injection into the floor of a post-ESD artificial ulcer promotes the formation of granulation tissue at an early stage of the healing process leading to regeneration of gastric mucosa without mucosal convergence or gastric deformity. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Bio-sheet graft therapy for artificial gastric ulcer after endoscopic submucosal dissection: an animal feasibility study.

    Science.gov (United States)

    Kwon, Chang-Il; Kim, Gwangil; Ko, Kwang Hyun; Jung, Yunho; Chung, Il-Kwun; Jeong, Seok; Lee, Don Haeng; Hong, Sung Pyo; Hahm, Ki Baik

    2015-04-01

    Various bio-sheet grafts have been attempted either to accelerate healing of artificial ulcers or to prevent adverse events after endoscopic submucosal dissection (ESD), but neither prospective nor mechanistic studies were available. To evaluate the substantial effect of a bio-sheet graft on artificial ulcer healing and its feasibility as an endoscopic treatment modality. Preclinical, in vivo animal experiment and proof-of-concept study. Animal laboratory. Three mini-pigs, Sus scrofa, mean age 14 months. Multiple ulcers sized 2.5 cm in diameter were generated by ESD in 3 mini-pigs and were assigned randomly into the following 3 groups; control group, bio-sheet group, or combination (bio-sheet plus drug) group. Bio-sheet grafts or bio-sheet plus drug combinations were applied on the artificial ulcers immediately after the ESD. Feasibility and efficacy of endoscopic bio-sheet graft therapy for the management of artificial ulcers and the evaluation of healing conditions based on histology changes in the remaining gastric bed tissues harvested from the stomachs. Thirty-three ESD specimens were obtained. On an image analysis of the ratio of healed area in the remaining gastric bed tissue compared with the matched dissected gastric mucosa, the control group showed the most significant improvement in healing activity among the 3 groups (P ulcer tissue was significantly attenuated in bio-sheet and combination groups (P gastric acid attack as reflected in the attenuated inflammation on the ulcer beds, unexpected delayed ulcer healing was noted in the bio-sheet graft group because of its physical hindrance of the healing process. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  14. High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs.

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    Pioche, Mathieu; Ciocirlan, Mihai; Lépilliez, Vincent; Salmon, Damien; Mais, Laetitia; Guillaud, Olivier; Hervieu, Valérie; Petronio, Marco; Lienhart, Isabelle; Adriano, Jean-Luc; Lafon, Cyril; Ponchon, Thierry

    2014-05-01

    Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system. This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures. All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001). This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.

  15. A comparison of sedation protocols for gastric endoscopic submucosal dissection: moderate sedation with analgesic supplementation vs analgesia targeted light sedation.

    Science.gov (United States)

    Yoo, Y C; Park, C H; Shin, S; Park, Y; Lee, S K; Min, K T

    2015-07-01

    Moderate to deep sedation has been recommended during endoscopic submucosal dissection (ESD). However, it is often accompanied by adverse events such as respiratory depression or aspiration pneumonia. This study investigated the respiratory complications and ESD outcomes of two sedation protocols: moderate sedation with analgesic supplementation (MSAS) and analgesia targeted light sedation (ATLS). The clinical data of 293 patients who underwent ESD between May and December 2012 were reviewed. During the first 4 months, 155 patients were managed by moderate sedation [Modified Observer Assessment of Alertness/Sedation (MOAA/S) at 2-3] with the MSAS protocol. During the latter period, 138 patients were managed using the ATLS protocol (MOAA/S at 4-5). For both protocols, propofol and remifentanil were infused for sedation and pain control, respectively. The ATLS protocol required less propofol [22.9 (sd 17.3) vs 88.1 (44.0) µg kg(-1) min(-1), PATLS protocol than with the MSAS protocol. The incidence of aspiration pneumonia with the ATLS protocol was 1.4% compared with 5.2% with the MSAS protocol (P=0.109). There were no differences in outcomes and complications of ESD. The ATLS protocol reduced the incidence of desaturation events without affecting ESD performance compared with the MSAS protocol. There was also a trend towards a low incidence of aspiration pneumonia with the ATLS protocol. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Spectral Computed Tomography Imaging of Gastric Schwannoma and Gastric Stromal Tumor.

    Science.gov (United States)

    Liu, Jianli; Chai, Yanjun; Zhou, Junlin; Dong, Chi; Zhang, Wenjuan; Liu, Bin

    Gastric schwannomas (GSs) and gastrointestinal stromal tumors (GSTs) are grossly similar submucosal neoplasms with different prognoses. We explored the value of spectral computed tomography (CT) to distinguish between them. Patients diagnosed with GS or GST at Lanzhou University Second Hospital, China, between May 2013 and June 2015 were included retrospectively. The subjects underwent spectral CT examination before surgery and had histologically confirmed diagnosis of GS or GST. Twelve patients with GS (3 men; 9 women; mean [SD] age, 47.0 [11.5] years) and 20 with GST (7 men; 13 women; mean [SD] age, 54.7 [9.9]) showed significant differences in terms of arterial phase (AP) at 70 keV (P < 0.001), portal phase (PP) at 70 keV (P = 0.002), AP iodine concentration, PP iodine concentration, AP water concentration, AP slope of spectral curve, and PP slope of spectral curve (all P < 0.001). Spectral CT may be useful for noninvasive diagnosis of submucosal tumors.

  17. Synovial Sarcoma-A Rare Tumor of the Larynx

    Directory of Open Access Journals (Sweden)

    Ghodrat Mohammadi

    2016-05-01

    Full Text Available Introduction: Malignant mesenchymal tumors of the larynx are rare. One type of malignant mesenchymal tumor is synovial sarcoma with unknown histogenesis, which occurs predominantly in the lower extremities of young adults. The head and neck region is a relatively rare location. There are few cases of malignant mesenchymal tumors with laryngeal localization in literature.  Case Report: In this report, a new case in a 23-year-old man, which was referred with increasing hoarseness for eight months, and dysphagia, odynophagia, and dyspnea since nearly one year ago, is reported. Indirect laryngoscopy revealed a laryngeal submucosal mass. The patient was operated and the histopathological diagnosis of synovial sarcoma was confirmed by IHC (Immunohistochemisry.  Conclusion:  Synovial sarcoma occurs predominantly in the lower extremities of young adults. Because very few cases of laryngeal synovial sarcoma are reported, every new case will bring some new information about diagnosis and therapy. It is of utmost importance to get to know new aspects and therapeutical modalities of this rare tumor.

  18. Preservation of the endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound ablation of submucosal uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young-sun [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); Uterine Fibroid Integrated Management Center, MINT Intervention Hospital, Department of Radiology, Seoul (Korea, Republic of); Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of); Lim, Hyo Keun [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); SAIHST, Sungkyunkwan University, Department of Health Sciences and Technology, Seoul (Korea, Republic of); Rhim, Hyunchul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); Jung, Sin-Ho [SAIHST, Sungkyunkwan University, Department of Health Sciences and Technology, Seoul (Korea, Republic of); Samsung Medical Center, Department of Biostatistics and Clinical Epidemiology, Seoul (Korea, Republic of); Ahn, Joong Hyun [Samsung Biomedical Research Institute, Samsung Medical Center, Biostatistics Team, Seoul (Korea, Republic of)

    2017-09-15

    To evaluate the integrity of endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of submucosal uterine fibroids based on contrast-enhanced MRI findings, and to identify the risk factors for endometrial impairment. In total, 117 submucosal fibroids (diameter: 5.9 ± 3.0 cm) in 101 women (age: 43.6 ± 4.4 years) treated with MR-HIFU ablation were retrospectively analysed. Endometrial integrity was assessed with contrast-enhanced T1-weighted images at immediate (n = 101), 3-month (n = 62) and 12-month (n = 15) follow-ups. Endometrial impairment was classified into grades 0 (continuous endometrium), 1 (pin-point, full-thickness discontinuity), 2 (between grade 1 and 3), or 3 (full-thickness discontinuity >1 cm). Risk factors were assessed with generalized estimating equation (GEE) analysis. Among 117 fibroids, grades 0, 1, 2 and 3 endometrial impairments were observed at initial examination in 56.4%, 24.8%, 13.7% and 4.3%, respectively. Among 37 fibroid cases of endometrial impairment for which follow-ups were conducted, 30 showed improvements at 3- and/or 12-month follow-up. GEE analysis revealed the degree of endometrial protrusion was significantly associated with severity of endometrial injury (P < 0.0001). After MR-HIFU ablation of submucosal fibroids, endometrial enhancement was preserved intact or minimally impaired in most cases. Impaired endometrium, which is more common after treating endometrially-protruded fibroids, may recover spontaneously. (orig.)

  19. [Prostaglandins and the immune response at the intestinal submucosal level. A potential site for interference with the repeated use of paracetamol and ibuprofen at a young age?].

    Science.gov (United States)

    Langhendries, J-P; Maton, P; François-Adant, A; Chantrain, C; Bury, F; Philippet, P

    2015-03-01

    Immune deviations have been shown to exponentially increase in young children. As a consequence, research investigating possible environmental reasons for this increase is considered a public health priority. An improved understanding of the immunity of the intestinal submucosal lamina propria has demonstrated the importance of prostaglandins (PGE2s) on its local development with general immune consequences further on. PGE2s appear at this intestinal submucosal level from the metabolism of arachidonic acid mediated by type-2 cyclooxygenases (COX2s) situated in the membranes of many immune cells. The potential risk of repeated inhibition of PGE2 synthesis at a young age has been demonstrated in experiments with animals systemically exposed to a non-steroidal anti-inflammatory drug (NSAID). The repeatedly exposed animal cannot develop tolerance to food antigens and exhibits autoimmune deviations. Acetaminophen (paracetamol) and ibuprofen are analgesic and antipyretic medications given to children either alone or in combination, most often without medical prescription. Recently, it has been demonstrated that paracetamol, like ibuprofen, also carries, besides its central action, a non-selective inhibitory action on peripheral COXs. However, this inhibitory action only relates to physiological concentrations of arachidonic acid and explains the difference in their respective anti-inflammatory effects. Since recently published data have repeatedly reported an increase of immune deviations associated with paracetamol exposure at a young age, it appears important to better understand the possible negative impact of excessive and repetitive inhibitions of the physiological synthesis of prostaglandins by COX2s in childhood during which all immune mechanisms are built up at the intestinal submucosal level. Therefore, a well-designed prospective strategy for pharmacovigilance of these COX inhibitors repeatedly given during childhood is urgently needed. Copyright © 2014

  20. Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the "non-extension sign" as a simple diagnostic marker.

    Science.gov (United States)

    Nagahama, Takashi; Yao, Kenshi; Imamura, Kentaro; Kojima, Toshiki; Ohtsu, Kensei; Chuman, Kenta; Tanabe, Hiroshi; Yamaoka, Rino; Iwashita, Akinori

    2017-03-01

    The ability to differentiate between mucosal (M) or microinvasive submucosal (SM1: depth of less than 500 µm) and invasive submucosal (SM2: depth of 500 µm or more) cancer is paramount when choosing the method of treatment for early gastric cancer (EGC). The "non-extension sign" relates to a localized increase in thickness and rigidity due to massive submucosal invasion by a cancer. The present study sought to assess the ability of conventional endoscopy (CE) to correctly identify SM2 cancer using only the non-extension sign. This is a retrospective study based on a prospectively collected database. EGCs had been diagnosed according to invasion depth as M-SM1 or SM2. In terms of the endoscopic diagnostic criterion, lesions positive for the non-extension sign were classified as SM2 cancers, while those negative for the non-extension sign were classified as M-SM1 cancers. Histopathological findings were used as the gold standard. We examined a total of 863 lesions from 704 patients, comprising 104 true-positive, 733 true-negative, 9 false-positive, and 17 false-negative lesions. This yielded a sensitivity of 92.0 % (95 % confidence interval (CI), 87.0-97.0 %), a specificity of 97.7 % (95 % CI, 96.7-98.8 %), a positive predictive value of 85.9 % (95 % CI, 79.7-92.1 %), a negative predictive value of 98.8 % (95 % CI, 98.0-99.6 %), and a diagnostic accuracy of 96.9 % (95 % CI, 95.8-98.1 %). The non-extension sign may be useful for accurately determining the suitability of minimally invasive endoscopic treatment. Nevertheless, considering the limitations of retrospective analysis, a further prospective study is warranted to confirm the diagnostic reliability of the non-extension sign.

  1. Comparison of ENDO CUT mode and FORCED COAG mode for the formation of stricture after esophageal endoscopic submucosal dissection in an in vivo porcine model.

    Science.gov (United States)

    Arao, Masamichi; Ishihara, Ryu; Tonai, Yusuke; Iwatsubo, Taro; Shichijyo, Satoki; Matsuura, Noriko; Nakahira, Hiroko; Yamamoto, Sachiko; Takeuchi, Yoji; Higashino, Koji; Uedo, Noriya; Nakatsuka, Shinichi

    2018-01-04

    Stricture is a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. To date, various methods have been developed to prevent stricture. However, the mechanism by which different electrosurgical unit (ESU) modes affect the formation of post-ESD stricture has not been evaluated. This study aimed to compare the degree of stricture caused by two major ESU modes (ENDO CUT mode and FORCED COAG mode) in a porcine model. Twelve ESD procedures covering half of the circumference were performed in six pigs. Mucosal incision was performed with a ball-tip flush knife and submucosal dissection was performed with a hook knife; the two modes used were ENDO CUT I (Effect 2, Duration 2, Interval 3) and FORCED COAG mode (Effect 3, 40 W) (VIO300D, ERBE Germany). The pigs were killed humanely 30 days after ESD, and the severity of stricture and fibrosis was assessed. The resected site of the esophagus showed complete mucosal regrowth and scar formation in all pigs. There was no significant difference between the two modes in procedure time and size of resected specimen (14.4 ± 2.4 and 15.9 ± 6.1 min, P = 0.589; 626 ± 148, 661 ± 186 mm 2 , P = 0.74, respectively). Stricture rate and severity of fibrosis in the submucosal layer were significantly lower in ENDO CUT mode than in FORCED COAG mode (31.5 ± 16.0% vs 44.3 ± 11.6%, P = 0.046; 36.2 ± 17.1% vs 60.4 ± 26.8%, P = 0.024, respectively). ENDO CUT mode showed promising ability to attenuate fibrosis and stricture after esophageal ESD.

  2. Tumor budding is associated with an increased risk of lymph node metastasis and poor prognosis in superficial esophageal adenocarcinoma.

    Science.gov (United States)

    Landau, Michael S; Hastings, Steven M; Foxwell, Tyler J; Luketich, James D; Nason, Katie S; Davison, Jon M

    2014-12-01

    The treatment approach for superficial (stage T1) esophageal adenocarcinoma critically depends on the pre-operative assessment of metastatic risk. Part of that assessment involves evaluation of the primary tumor for pathologic characteristics known to predict nodal metastasis: depth of invasion (intramucosal vs submucosal), angiolymphatic invasion, tumor grade, and tumor size. Tumor budding is a histologic pattern that is associated with poor prognosis in early-stage colorectal adenocarcinoma and a predictor of nodal metastasis in T1 colorectal adenocarcinoma. In a retrospective study, we used a semi-quantitative histologic scoring system to categorize 210 surgically resected, superficial (stage T1) esophageal adenocarcinomas according to the extent of tumor budding (none, focal, and extensive) and also evaluated other known risk factors for nodal metastasis, including depth of invasion, angiolymphatic invasion, tumor grade, and tumor size. We assessed the risk of nodal metastasis associated with tumor budding in univariate analyses and controlled for other risk factors in a multivariate logistic regression model. In all, 41% (24 out of 59) of tumors with extensive tumor budding (tumor budding in ≥3 20X microscopic fields) were metastatic to regional lymph nodes, compared with 10% (12 out of 117) of tumors with no tumor budding, and 15% (5 out of 34) of tumors with focal tumor budding (Ptumor budding remains an independent risk factor for lymph node metastasis in superficial esophageal adenocarcinoma associated with a 2.5-fold increase (95% CI=1.1-6.3, P=0.039) in the risk of nodal metastasis. Extensive tumor budding is also a poor prognostic factor with respect to overall survival and time to recurrence in univariate and multivariate analyses. As an independent risk factor for nodal metastasis and poor prognosis after esophagectomy, tumor budding should be evaluated in superficial (T1) esophageal adenocarcinoma as a part of a comprehensive pathologic risk

  3. Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia.

    Science.gov (United States)

    Liu, Bing-Rong; Song, Ji-Tao; Kong, Ling-Jian; Pei, Feng-Hua; Wang, Xin-Hong; Du, Ya-Ju

    2013-11-01

    Endoscopic resection of esophageal or cardial subepithelial tumors (SETs) originating from the muscularis propria (MP) is rarely done due to the high risk of perforation, fistula formation, and secondary infection. The aim of this study was to evaluate the preliminary clinical feasibility and safety of tunneling endoscopic muscularis dissection (tEMD) for resection of SETs located in the esophagus and gastric cardia Twelve patients with SETs originating from the MP of the esophagus (n = 7) or cardia (n = 5) were treated by tEMD. The procedure included creation of a submucosal tunnel to reach the tumor, dissection of the tumor from the surrounding submucosal tissue and the unaffected MP layer, full-thickness resection of the tumor and affected MP, and subsequent closure of the tunnel mucosal entry with endoscopic clips. The en bloc resection rate was 100 % (seven lesions affected the deep MP so complete MP resection was performed; five lesions affected the superficial MP for a partial MP resection). The average tumor size was 18.5 ± 6.9 (range 10-30) mm. The mean operating time was 78.3 ± 25.5 (range 50-130) min. The histological diagnoses were two gastrointestinal stromal tumors with very low risk, nine leiomyomas, and one schwannoma. Air leakage and effusion included subcutaneous and mediastinal emphysema in eight patients (66.7 %), pneumothorax in four (33.3 %), pneumoperitoneum in three (25.0 %), and small pleural effusion in two (16.7 %). All air leakage and effusion cases were resolved with conservative management. No patient developed delayed hemorrhage and chronic fistula after tEMD. During the mean follow-up time of 7.1 ± 4.3 (range 2-15) months, no tumor recurrence was found in any patient. tEMD appears to be a feasible minimally invasive and effective treatment for patients with SETs originating from the MP layer of the esophagus and cardia.

  4. Rare Presentations of Epstein-Barr Virus--Associated Smooth Muscle Tumor in Children.

    Science.gov (United States)

    Arva, Nicoleta C; Schafernak, Kristian T

    2016-01-01

    Epstein-Barr virus (EBV) has oncogenic potential and has been implicated in the etiology of a wide range of malignancies. Certain EBV-driven neoplasms, such as smooth muscle tumors (SMTs), manifest typically in immunocompromised patients. In children, these neoplasms have been encountered in the setting of primary immune disorders, specifically severe combined and common variable immunodeficiency syndromes. Human immunodeficiency virus infection and posttransplant immunosuppression, in particular liver and kidney transplantation, likewise increase the risk in the pediatric population. The location of these neoplasms appears related to the type of immunodeficiency: in acquired immunodeficiency syndrome they are frequently located intracranially or intraspinally, whereas after transplant they usually involve the liver or lung. We report 2 distinct cases of EBV-related SMT, unique through their coassociated immunosuppressive state or location: the 1st occurred in a patient with immunodeficiency secondary to NEMO gene mutation following hematopoietic stem cell transplantation; the 2nd developed in the orbit after heart transplant.

  5. Tumor Types: Understanding Brain Tumors

    Science.gov (United States)

    ... to reveal the vast diversity of genetic and epigenetic alterations that exist between brain tumors. This biological ... social workers, psychologists, and nurses. A supportive family environment is also helpful. Surgery GBM’s capacity to wildly ...

  6. Primary Myofibroblasts Maintain Short-Term Viability following Submucosal Injection in Syngeneic, Immune-Competent Mice Utilizing Murine Colonoscopy.

    Directory of Open Access Journals (Sweden)

    Hassan A Khalil

    Full Text Available The myofibroblast is an important stromal cell of the gastrointestinal tract. Current in vitro and in vivo models either do not accurately recreate stromal-epithelial interactions or are not specific to myofibroblasts. We sought to create an animal model that would allow the study of myofibroblast-epithelial interactions. We isolated and cultured colonic myofibroblasts from FVB mice. Cells were α-SMA and vimentin positive but desmin negative on immunoblot analysis. We injected the myofibroblasts into the colonic submucosa of syngeneic adult mice (n = 8 via a miniendoscopic system. We then isolated green fluorescent protein (GFP positive colonic myofibroblasts from C57BL/6-Tg(CAG-EGFP1Osb/J mice and injected them into the colonic lamina propria of C57BL/6J mice at 1x10(5 (n = 14, 1x10(6 (n = 9, or 5x10(6 cells/mL (n = 4. A subset of mice were injected with serum-free media and ink without cells (n = 3. Mice underwent repeat endoscopy and euthanasia one or 7 days after injection. Colons were isolated and either fixed in 10% formalin or the inked sites were individually excised and lysed for DNA. We assessed the injection sites via histology and immunohistochemical stains for α-SMA and GFP. We used qPCR to quantify GFP DNA transcripts at the lamina propria injection sites. Submucosal injection of myofibroblasts resulted in the formation of a subepithelial wheal on endoscopy, which persisted to day 7. Myofibroblasts injected either into the submucosa or lamina propria maintained viability on post-injection day 7 as evidenced by positive α-SMA staining. qPCR of lamina propria injections showed a dose-dependent increase in GFP DNA transcripts on post-injection day 1, whereas the number of transcripts on day 7 was equivalent for the concentrations injected. We demonstrate short-term survival of primary cultured colonic myofibroblasts in syngeneic mice. This may prove to be a valuable model for studying the role of myofibroblasts in states of health

  7. CO2 insufflation versus air insufflation for endoscopic submucosal dissection: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Li, Xuan; Dong, Hao; Zhang, Yifeng; Zhang, Guoxin

    2017-01-01

    Carbon dioxide (CO2) insufflation is increasingly used for endoscopic submucosal dissection (ESD) owing to the faster absorption of CO2 as compared to that of air. Studies comparing CO2 insufflation and air insufflation have reported conflicting results. This meta-analysis is aimed to assess the efficacy and safety of use of CO2 insufflation for ESD. Clinical trials of CO2 insufflation versus air insufflation for ESD were searched in PubMed, Embase, the Cochrane Library and Chinese Biomedical Literature Database. We performed a meta-analysis of all randomized controlled trials (RCTs). Eleven studies which compared the use of CO2 insufflation and air insufflation, with a combined study population of 1026 patients, were included in the meta-analysis (n = 506 for CO2 insufflation; n = 522 for air insufflation). Abdominal pain and VAS scores at 6h and 24h post-procedure in the CO2 insufflation group were significantly lower than those in the air insufflation group, but not at 1h and 3h after ESD. The percentage of patients who experienced pain 1h and 24h post-procedure was obviously decreased. Use of CO2 insufflation was associated with lower VAS scores for abdominal distention at 1h after ESD, but not at 24h after ESD. However, no significant differences were observed with respect to postoperative transcutaneous partial pressure carbon dioxide (PtcCO2), arterial blood carbon dioxide partial pressure (PaCO2), oxygen saturation (SpO2%), abdominal circumference, hospital stay, white blood cell (WBC) counts, C-Reactive protein (CRP) level, dosage of sedatives used, incidence of dysphagia and other complications. Use of CO2 insufflation for ESD was safe and effective with regard to abdominal discomfort, procedure time, and the residual gas volume. However, there appeared no significant differences with respect to other parameters namely, PtcCO2, PaCO2, SpO2%, abdominal circumference, hospital stay, sedation dosage, complications, WBC, CRP, and dysphagia.

  8. Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar.

    Science.gov (United States)

    Ehsan, Afeefa; Ali Bukhari, Syed Gulzar; Ashar; Manzoor, Arslan; Junaid, Muhammad

    2014-07-01

    To determine the effects of pre-operative submucosal dexamethasone injection on postoperative swelling and trismus following surgical extraction of mandibular third molar. Randomized controlled trial. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry (AFID), Rawalpindi, from October 2009 to March 2010. A total of 100 patients aged 18 - 40 years with good periodontal health and mesioangular impaction were divided in two treatment groups (50 in each group). Group-A received prophylactic 4 mg submucosal dexamethasone intraoral injection and Group-B acted as control group. Facial swelling and trismus were assessed at baseline, 2nd and 7th postoperative days. Data was analyzed using SPSS-10. There were 35 (70%) males and 15 (30%) females in group-A and 34 (68%) males and 16 (32%) females in group-B. Surgical time ranged from 30 - 50 minutes (mean = 40.62 ± 4.886 minutes) for group-A and 33 - 50 minutes (mean = 42.12 ± 4.543 minutes) for group-B. Administration of dexamethasone had statistically significant effect in reduction of swelling and trismus on second postoperative day (p trismus.

  9. Endoscopic submucosal dissection for early gastric cancer on the lesser curvature in upper third of the stomach is a risk factor for postoperative delayed gastric emptying.

    Science.gov (United States)

    Yoshizaki, Tetsuya; Obata, Daisuke; Aoki, Yasuhiro; Okamoto, Norihiro; Hashimura, Hiroki; Kano, Chise; Matsushita, Megumi; Kanamori, Atsushi; Matsumoto, Kei; Tsujimae, Masahiro; Momose, Kenji; Eguchi, Takaaki; Okuyama, Shunsuke; Yamashita, Hiroshi; Fujita, Mikio; Okada, Akihiko

    2018-02-07

    Advances in Endoscopic submucosal dissection (ESD) technology have established ESD for early gastric cancer as a safe and stable technique. However, ESD may induce delayed gastric emptying and the cause of food residue retention in the stomach after ESD is not clear. This study aimed to clarify risk factors for delayed gastric emptying with food retention after gastric ESD. We retrospectively examined for food residue in the stomach 1 week after ESD was performed for early gastric carcinoma at Osaka Saiseikai Nakatsu Hospital from February 2008 to November 2016. Food residue was observed in 68 (6.1%) of 1114 patients who underwent gastric ESD. The percentage of lesions located on the lesser curvature of the upper third of the stomach was 45.6% (31/68) in the food residue group and 3.5% (37/1046) in the non-food residue group, which was significantly different (P gastric ESD. Of the 68 patients, 3 had food residue in the stomach on endoscopic examination for follow-up observation after the ESD ulcer had healed. Delayed gastric emptying with food retention after gastric ESD was associated with lesions located in the lesser curvature of the upper stomach, submucosal invasion of the lesion, age older than 80 years, and post-ESD bleeding, though it was temporary in most cases.

  10. Tumoral calcinosis

    Directory of Open Access Journals (Sweden)

    Rao M

    1995-01-01

    Full Text Available Tumoral calcinosis is an unusual clinical disorder in which large masses of calcium are deposited in the periarticular tissues of the body. The characteristic clinical, radiological and histopathological features of this disorder occurring in three middle aged female patients are reported.

  11. Pituitary Tumors

    Science.gov (United States)

    ... Health and Human Development (NICHD) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) See all related organizations Publications Tumores de la glándula pituitaria Order NINDS Publications Definition The pituitary is a small, bean-sized gland ...

  12. Benign Tumors

    Science.gov (United States)

    ... cannot spread or invade other parts of your body. Even so, they can be dangerous if they press on vital organs, such as your brain. Tumors are made up of extra cells. Normally, cells grow and divide to form new cells as your body needs them. When cells grow old, they die, ...

  13. Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: A Systematic Review and Meta-Analysis

    NARCIS (Netherlands)

    Backes, Y.; Moss, A.; Reitsma, J.B.; Siersema, P.D.; Moons, L.M.

    2017-01-01

    OBJECTIVES: Optical diagnosis of T1 colorectal cancer (CRC) and T1 CRC with deep submucosal invasion is important in guiding the treatment strategy. The use of advanced imaging is not standard clinical practice in Western countries. A systematic review and meta-analysis were conducted comparing the

  14. [Neonatal tumors].

    Science.gov (United States)

    Costa, Carla; Rocha, Gustavo; Grilo, Marta; Bianchi, Ricardo; Sotto Mayor, Tânia; Monteiro, Joaquim; Guimarães, Hercília

    2010-01-01

    Tumors affecting the fetus and newborn differ from those found in older children and adults, leading to new diagnostic and therapeutic challenges. To evaluate the main clinical aspects related to neonatal tumors. Retrospective analysis of clinical data from newborn patients admitted to the Service of Neonatology of São João Hospital between 1996 and 2006, with the diagnosis of tumor or neoplasia. Total = 32 cases, 16M/16F, birth weight: 3146 g (965-4590), gestational age 38 weeks (28-41), seven (22%) preterm, C-section rate 75% (n = 24), two with EXIT procedure. Teratoma (n = 8); lymphangioma (n = 7), neuroblastoma (n = 6), haemangioma (n = 5), other solid tumors (n = 6); acute lymphoblastic leukemia (n = 1). Prenatal diagnosis 50% (n = 16). Teratoma: immature (n = 3); mature (n = 5), sacrococcygeal location (n = 5); cervical (n = 3); total macroscopic resection (n = 8). Cystic lymphangioma: cervical location (n = 5); cervicothoracic location (n = 1); thoracoabdominal location (n = 1); total macroscopic resection (n = 7). NEUROBLASTOMA: abdominal location (n = 5); cervical location (n = 1); deletion 1p (n = 0); oncogene n-myc amplification (n = 0); stage I (n = 1); IIB (n = 1); III (n = 3); IV (n = 1). Chemotherapy (n = 5), according to the (n = 2), surgical resection (n = 4). Four patients remain without disease and two present with residual disease. OTHER SOLID TUMORS: Large haemangiomas (n = 5); scaly papiloma (n = 1); juvenile xanthogranuloma (n = 1); lipoblastoma (n = 1); nephroma (n = 1); nonclassified neoplasm, possible nervous sheath sarcoma (n = 1). All patients showed a good clinical evolution. Acute lymphoblast leukemia (n = 1), deceased. Pre-natal diagnosis allows the planning of a careful multidisciplinary approach. In these rare entities it is crucial to pursue international collaboration, ideally workgroup committees, aiming for better clinical knowledge and an improved prognosis.

  15. Temporal evolution of multidetector CT findings after endoscopic submucosal dissection in patients with early gastric cancer: Correlation with endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Yeo, Dong Myung, E-mail: duehdaud@gmail.com [Department of Radiology, Yeouido St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of); Chung, Dong Jin, E-mail: bookdoo7@catholic.ac.kr [Department of Radiology, Yeouido St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of); Cheung, Dae Young, E-mail: adagio@catholic.ac.kr [Department of Internal Medicine, Yeouido St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of); Lee, Jae Mun, E-mail: jaemun@catholic.ac.kr [Department of Radiology, Yeouido St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of)

    2014-06-15

    Objective: To assess changes over time in imaging findings retrospectively by multidetector CT (MDCT) with two-dimensional (2D) multiplanar reconstruction and three-dimensional (3D) CT gastrography (CTG), after endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC), and to correlate 3D CT images with endoscopic appearance. Materials and methods: In this retrospective study, a total of 84 patients underwent ESD and were followed up with MDCT. Fifteen patients underwent CT twice, and 3 patients underwent CT 3 times. A total of 105 CTs were included in this study and 43 CTs contained 3D CTGs. Two radiologists in consensus interpreted CT images for lesion detectability, presence and characteristics of ulcer, focal wall thickening, perigastric fat infiltration, and overlying enhancing layer in 2D images. The presence of ulcer or subtle mucosal nodularity, ulcer mound, and fold convergence were analysed in 3D CT images. We also assessed the time interval between ESD and CT and analysed the temporal evolution of CT findings. The sensitivity, specificity, and overall accuracy of 3D CTG were assessed regarding endoscopic features as the gold standard. Results: The mean interval between ESD and follow up CT was 76.9 days (median, 62; range, 2–223). No tumour recurrence in any lesion was found on follow-up endoscopic biopsy and also lymph node or distant metastasis was not observed on CT exams in the follow-up period. The lesion detectability in a total of 105 post-ESD 2D CT images was 42.0% (44/105), and 93.2% (41/44) of the detected lesions were visualizable 2 months after ESD. Focal wall thickening was observed during the entire follow-up period in all patients. Perigastric fat infiltration was observed in 4 lesions within 1 week of ESD. Overlying enhancing layer appeared in 27 lesions without temporal evolution. On a total of 43 post-ESD 3D CTG, lesion detectability was 76.7% (33/43), and lesions could be visualized for a longer period than

  16. Tumor thrombus

    DEFF Research Database (Denmark)

    Ravina, Mudalsha; Hess, Søren; Chauhan, Mahesh Singh

    2014-01-01

    PURPOSE: Thrombosis in cancer may manifest itself as venous thromboembolic disease or tumor thrombosis (TT). We present our experience with incidentally detected TT on FDG PET/CT in 21 oncologic patients. PATIENTS AND METHODS: We retrospectively reviewed all FDG PET/CT examinations during a 5-year......-one patients were included; the most common malignancies were renal cell carcinoma (n=6), hepatocellular carcinoma (n=3), and lung cancer (n=3). Indication for the scan was initial staging (n=15) and suspected recurrence (n=6). Several vessels were affected, the most common was the inferior vena cava (n=14......), but most other major branches of the venous vasculature was represented, and some patients had thrombi in several vessels. FDG uptake was linear in 7 patients, linear with a dilated vessel in 6 patients, and focal in 7 patients. The mean SUVmax of the primary tumors was 10.3 (range, 2.6-31.2; median, 6...

  17. Brain tumor - primary - adults

    Science.gov (United States)

    ... Vestibular schwannoma (acoustic neuroma) - adults; Meningioma - adults; Cancer - brain tumor (adults) ... Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, ...

  18. Understanding Brain Tumors

    Science.gov (United States)

    ... to Know About Brain Tumors . What is a Brain Tumor? A brain tumor is an abnormal growth
 ... Tumors” from Frankly Speaking Frankly Speaking About Cancer: Brain Tumors Download the full book Questions to ask ...

  19. Brain tumor - children

    Science.gov (United States)

    ... children; Neuroglioma - children; Oligodendroglioma - children; Meningioma - children; Cancer - brain tumor (children) ... The cause of primary brain tumors is unknown. Primary brain tumors may ... (spread to nearby areas) Cancerous (malignant) Brain tumors ...

  20. Benign Liver Tumors

    Science.gov (United States)

    ... While You Shop Contact Us Donate Now Benign Liver Tumors Back A tumor is an abnormal growth ... health risk. Frequently Asked Questions How are benign liver tumors detected? In most cases, benign liver tumors ...

  1. Adrenal Gland Tumors: Statistics

    Science.gov (United States)

    ... Gland Tumor: Statistics Request Permissions Adrenal Gland Tumor: Statistics Approved by the Cancer.Net Editorial Board , 03/ ... primary adrenal gland tumor is very uncommon. Exact statistics are not available for this type of tumor ...

  2. Brain tumor (image)

    Science.gov (United States)

    Brain tumors are classified depending on the exact site of the tumor, the type of tissue involved, benign ... tendencies of the tumor, and other factors. Primary brain tumors can arise from the brain cells, the meninges ( ...

  3. Pediatric brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Poussaint, Tina Y. [Department of Radiology, Boston, MA (United States); Panigrahy, Ashok [Children' s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Huisman, Thierry A.G.M. [Charlotte R. Bloomberg Children' s Center, Johns Hopkins Hospital, Division of Pediatric Radiology and Pediatric Neuroradiology, Baltimore, MD (United States)

    2015-09-15

    Among all causes of death in children from solid tumors, pediatric brain tumors are the most common. This article includes an overview of a subset of infratentorial and supratentorial tumors with a focus on tumor imaging features and molecular advances and treatments of these tumors. Key to understanding the imaging features of brain tumors is a firm grasp of other disease processes that can mimic tumor on imaging. We also review imaging features of a common subset of tumor mimics. (orig.)

  4. Syntactically lexicalized phrase-based SMT

    NARCIS (Netherlands)

    Hassan, H.; Sima'an, K.; Way, A.

    2008-01-01

    Until quite recently, extending phrase-based statistical machine translation (PBSMT) with syntactic knowledge caused system performance to deteriorate. The most recent successful enrichments of PBSMT with hierarchical structure either employ nonlinguistically motivated syntax for capturing

  5. Cholecystokinin expression in tumors

    DEFF Research Database (Denmark)

    Rehfeld, Jens F

    2016-01-01

    in different neuroendocrine tumors; cerebral gliomas and astrocytomas and specific pediatric tumors. Tumor hypersecretion of CCK was recently reported in a patient with a metastatic islet cell tumor and hypercholecystokininemia resulting in a novel tumor syndrome, the cholecystokininoma syndrome. This review...

  6. Role of second-look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: A systematic review and meta-analysis.

    Science.gov (United States)

    Kim, Eun Hye; Park, Se Woo; Nam, Eunwoo; Eun, Chang Soo; Han, Dong Soo; Park, Chan Hyuk

    2017-04-01

    Although several studies have shown that second-look endoscopy does not affect the incidence of bleeding after gastric endoscopic submucosal dissection (ESD), the potential roles of second-look endoscopy have not been fully evaluated. This study aimed to determine the role of second-look endoscopy after ESD through a systematic review and meta-analysis. This study conducted a systematic literature search of MEDLINE, EMBASE, and the Cochrane Library through March 2016 using the keywords "second-look," "prophylactic hemostasis," "prophylactic haemostasis," "prevention," "prophylaxis," and "endoscopic submucosal dissection." Studies were included if they evaluated the incidence of post-ESD bleeding according to second-look endoscopy or prophylactic hemostasis during second-look endoscopy. Four randomized controlled trials on post-ESD bleeding between second-look endoscopy and no second-look endoscopy and 12 non-randomized studies with a cohort design on post-ESD bleeding were included. On meta-analysis, second-look endoscopy did not affect delayed post-ESD bleeding (odds ratio [95% confidence interval] = 1.27 [0.80-2.00], I 2  = 0%). During second-look endoscopy, patients who were considered as high-risk for post-ESD bleeding underwent prophylactic hemostasis. Delayed post-ESD bleeding was more common in patients who were treated with hemostasis during second-look endoscopy compared with those who were not (odds ratio [95% confidence interval] = 3.40 [1.87-6.18], I 2  = 62%). In patients who underwent prophylactic hemostasis, the number needed to prolong a hospitalization period to avoid one additional post-ESD bleeding after discharge was 25. Second-look endoscopy after ESD could not reduce the risk of delayed post-ESD bleeding. Delayed post-ESD bleeding was more common in patients who underwent prophylactic hemostasis than in those who did not. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  7. [Calcifying epithelial odontogenic tumor (Pindborg tumor)].

    Science.gov (United States)

    Szporek, Bozena J; Cieślik, Tadeusz; Jedrzejewski, Piotr W; Lipiarz, Ludwik Z

    2005-01-01

    The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm which was first described by Pindborg in 1955 representing only 1% of all odontogenic tumors. The tumor has an ectodermal odontogenic origin. This tumor are considered benign but can be locally aggressive in nature with recurrence rates of 10-15% reported. Surgical treatment varies from simply enucleation to partial resection of the affected bone. Since 1973 three cases only of the Pinborg tumor have been presented in the Polish literature. We described the case of a 44-year-old man with Pindborg tumor in the right maxilla. Standard x-ray examinations and CT scan were performed in order to obtain information about tumor's localization. Autors discuss the radiologic features of calcifying epithelial odontogenic tumor and treatment method and the relevant literature.

  8. Childhood Brain Tumors

    Science.gov (United States)

    Brain tumors are abnormal growths inside the skull. They are among the most common types of childhood ... still be serious. Malignant tumors are cancerous. Childhood brain and spinal cord tumors can cause headaches and ...

  9. Brain Tumors (For Parents)

    Science.gov (United States)

    ... Needs a Kidney Transplant Vision Facts and Myths Brain Tumors KidsHealth > For Parents > Brain Tumors Print A ... radiation therapy or chemotherapy, or both. Types of Brain Tumors There are many different types of brain ...

  10. Pediatric Brain Tumor Foundation

    Science.gov (United States)

    ... navigate their brain tumor diagnosis. WATCH AND SHARE Brain tumors and their treatment can be deadly so ... Pediatric Central Nervous System Cancers Read more >> Pediatric Brain Tumor Foundation 302 Ridgefield Court, Asheville, NC 28806 ...

  11. Hand and Wrist Tumors

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Hand Tumors and Wrist Tumors Email to a friend * ... are seen commonly. CAUSES Common Types of Wrist Hand Tumors Ganglion Cysts (Figure 1): This is the ...

  12. Brain Tumor Diagnosis

    Science.gov (United States)

    ... Young Adult Guidelines For brain tumor information and support Call: 800-886-ABTA (2282) or Complete our contact form Brain Tumor Information Brain Anatomy Brain Tumor Symptoms Diagnosis Newly Diagnosed Neurological Exam ...

  13. Brain Tumor Symptoms

    Science.gov (United States)

    ... Young Adult Guidelines For brain tumor information and support Call: 800-886-ABTA (2282) or Complete our contact form Brain Tumor Information Brain Anatomy Brain Tumor Symptoms Headaches Seizures Memory Depression Mood ...

  14. Tumors and Pregnancy

    Science.gov (United States)

    Tumors during pregnancy are rare, but they can happen. Tumors can be either benign or malignant. Benign tumors aren't cancer. Malignant ones are. The most common cancers in pregnancy are breast cancer, cervical cancer, lymphoma, and melanoma. ...

  15. Neuroendocrine Tumor: Statistics

    Science.gov (United States)

    ... Tumor > Neuroendocrine Tumor: Statistics Request Permissions Neuroendocrine Tumor: Statistics Approved by the Cancer.Net Editorial Board , 11/ ... the body. It is important to remember that statistics on the survival rates for people with a ...

  16. DCB - Tumor Metastasis Research

    Science.gov (United States)

    Tumor metastasis research examines the mechanisms that allow cancer cells to leave the primary tumor and spread to another part of the body. Learn about recent tumor metastasis research studies supported by the Division of Cancer Biology.

  17. A safe transoral surgical approach to parapharyngeal tumor arising from deep lobe of parotid gland

    Directory of Open Access Journals (Sweden)

    Manuele Casale

    2016-12-01

    Full Text Available The management of parapharyngeal tumor is surgical, but the approach remains a challenge. Attention should be paid to avoidance intra-operative bleeding or cranial nerves damage. We report a case of a 67-year-old male complaining of left-ear fullness. A submucosal mass arising from the lateral wall of oropharynx on the left side was observed. Magnetic resonance imaging detected a mass arising from the parotid gland, in particular from the deep lobe, and a fine needle biopsy was compatible with “Warthin tumor.” We performed a mini-invasive transoral approach under magnification, previous isolation of homolateral vessels. The decision on which surgical approach to be used is determined by site, size vascularity, and histology of the tumor. A literature review of the main surgical approaches was performed. We performed a combined transoral dissection under magnification with cervicotomic exposure of the neck vascular bundle allowing to dissect the tumor and manage any intra-operative complications.

  18. Gastrointestinal stromal tumor (GIST coexisting with pancreatic cancer and hepatic hemangioma

    Directory of Open Access Journals (Sweden)

    M. A. Beltrán

    2014-11-01

    Full Text Available The occurrence of gastric gastrointestinal stromal tumors (GIST associated to pancreatic adenocarcinoma has been reported in 0.2% pancreatic cancers. There are no published reports on distal pancreatic adenocarcinoma associated to gastric antral GIST. Herein, we discuss a 75 years-old female patient who was admitted to our institution with upper digestive hemorrhage. The endoscopy showed large, superficial erosions over the cardias and, on the posterior wall of the antrum, a rounded sub-mucosal non-eroded lesion suspected of gastric GIST. An abdominal computed tomography scan found a hepatic hemangioma on the left hepatic lobe. In the pancreatic distal body and tail a solid exophytic lesion was identified. The surgical findings confirmed the radiologic diagnostic. The biopsy reported a hepatic hemangioma. The pancreatic tail and the proximal part of the body harbored a well-differentiated ductal adenocarcinoma measuring 3.4 cm x 3 cm x 2.5 cm with negative margins. The gastric tumor measured 4 cm x 2.5 cm x 1 cm, was positive for CD117, CD34, and DOG-1; it had a positive Ki67 in less than 2%, and 2 or less mitoses per 50 high-power fields. This uncommon case illustrates the occurrence of synchronous tumors of different cellular origins in the same patient, which were diagnosed during the study for another unrelated condition. The individual incidence of these tumors is low and if associated they probably will continue to be found incidentally.

  19. Circulating Tumor Cells

    National Research Council Canada - National Science Library

    Vicki Plaks; Charlotte D. Koopman; Zena Werb

    2013-01-01

    .... During successful dissemination, tumor cells invade the surrounding tissue of the primary tumor, intravasate into blood and lymphatic vessels, translocate to distant tissues, extravasate, adapt...

  20. A Comparative Study on the Efficacy of Submucosal Injection of Dexamethasone Versus Methylprednisolone in Reducing Postoperative Sequelae After Third Molar Surgery.

    Science.gov (United States)

    Lim, Daniel; Ngeow, Wei Cheong

    2017-06-08

    To compare the efficacy of preoperative submucosal injection of 4 mg of dexamethasone versus 40 mg of methylprednisolone in reducing postoperative sequelae after surgical removal of impacted mandibular third molars. This prospective, randomized, double-blind study included 65 patients who required surgical removal of impacted mandibular third molars with Class II or position B impaction (Pell and Gregory classification). Patients were randomly assigned to 1 of 3 groups: dexamethasone, methylprednisolone, or placebo (control). Surgery was performed with patients under local anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on postoperative day 1, 2, 5, and 7 to measure postoperative facial swelling by use of 2 linear measurements: interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Wound healing also was assessed on postoperative day 7. Descriptive and multivariate statistics were computed, and significance was set at P < .05. Both methylprednisolone and dexamethasone significantly reduced swelling and trismus (P < .05, Kruskal-Wallis test), whereas the methylprednisolone group had significantly less pain (P < .05, Kruskal-Wallis test) and consumed a lower amount of analgesics (P < .05, χ(2) test) during the early postoperative days. The study findings suggest that a single preoperative dose of dexamethasone versus methylprednisolone was equally effective in reducing postoperative swelling and trismus. Pain control by these corticosteroids, however, was variable. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

    Science.gov (United States)

    Ntourakis, Dimitrios; Mavrogenis, Georgios

    2015-01-01

    AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. CONCLUSION: Along with

  2. Malignant phyllodes breast tumor

    OpenAIRE

    Lisa R. Shah-Patel, MD

    2017-01-01

    Malignant phyllodes tumor is a rare tumor of the breast occurring in females usually between the ages of 35 and 55 years. It is often difficult to distinguish benign from malignant phyllodes tumors from other benign entities such as fibroadenomas. This case presentation demonstrates a woman with malignant phyllodes tumor treated with mastectomy with abdominal skin flap reconstruction.

  3. Malignant phyllodes breast tumor

    Directory of Open Access Journals (Sweden)

    Lisa R. Shah-Patel, MD

    2017-12-01

    Full Text Available Malignant phyllodes tumor is a rare tumor of the breast occurring in females usually between the ages of 35 and 55 years. It is often difficult to distinguish benign from malignant phyllodes tumors from other benign entities such as fibroadenomas. This case presentation demonstrates a woman with malignant phyllodes tumor treated with mastectomy with abdominal skin flap reconstruction.

  4. Pediatric Odontogenic Tumors.

    Science.gov (United States)

    Abrahams, Joshua M; McClure, Shawn A

    2016-02-01

    Pediatric odontogenic tumors are rare, and are often associated with impacted teeth. Although they can develop anywhere in the jaws, odontogenic tumors mainly occur in the posterior mandible. This article discusses the diagnosis and treatment of the most common pediatric odontogenic tumors, such as ameloblastoma, keratocystic odontogenic tumor, odontoma, and cementoblastoma. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Liver Tumors (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Liver Tumors KidsHealth / For Parents / Liver Tumors What's in this article? Types of Tumors ... Cancerous) Tumors Symptoms Diagnosis Treatment Coping Print The liver is the body's largest solid organ. Lying next ...

  6. Supratentorial tumors; Supratentorielle Tumoren

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.; Dillmann, K.; Roth, C.; Backens, M.; Reith, W. [Universitaetsklinikum Saarland, Homburg (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie

    2007-06-15

    Magnetic resonance imaging is a routine diagnostic measure for a suspected intracerebral mass. Computed tomography is usually also indicated. Further diagnostic procedures as well as the interpretation of the findings vary depending on the tumor location. This contribution discusses the symptoms and diagnostics for supratentorial tumors separated in relation to their intra- or extracranial location. Supratentorial tumors include astrocytoma, differentiated by their circumscribed and diffuse growth, ganglioglioma, ependyoma, neurocytoma, primitive neuroectodermal tumors (PNET), oligodendroglioma, dysembryoplastic neuroepithelial tumors (DNET), meningoangiomatosis, pineal tumors, hamartoma, lymphoma, craniopharyngeoma and metastases. The supratentorial extracranial tumors include the choroid plexus, colloid cysts, meningeoma, infantile myofibromatosis and lipoma. The most common subforms, especially of astrocytoma, will also be presented. (orig.)

  7. Cardiac Tumors; Tumeurs cardiaques

    Energy Technology Data Exchange (ETDEWEB)

    Laissy, J.P.; Fernandez, P. [Centre Hospitalier Universitaire Bichat Claude Bernard, Service d' Imagerie, 76 - Rouen (France); Mousseaux, E. [Hopital Europeen Georges Pompidou (HEGP), Service de Radiologie Cardio Vasculaire et Interventionnelle, 75 - Paris (France); Dacher, J.N. [Centre Hospitalier Universitaire Charles Nicolle, 75 - Rouen (France); Crochet, D. [Centre Hospitalier Universitaire, Hopital Laennec, Centre Hemodynamique, Radiologie Thoracique et Vasculaire, 44 - Nantes (France)

    2004-04-01

    Metastases are the most frequent tumors of the heart even though they seldom are recognized. Most primary cardiac tumors are benign. The main role of imaging is to differentiate a cardiac tumor from thrombus and rare pseudo-tumors: tuberculoma, hydatid cyst. Echocardiography is the fist line imaging technique to detect cardiac tumors, but CT and MRl arc useful for further characterization and differential diagnosis. Myxoma of the left atrium is the most frequent benign cardiac tumor. It usually is pedunculated and sometimes calcified. Sarcoma is the most frequent primary malignant tumor and usually presents as a sessile infiltrative tumor. Lymphoma and metastases are usually recognized by the presence of known tumor elsewhere of by characteristic direct contiguous involvement. Diagnosing primary and secondary pericardial tumors often is difficult. Imaging is valuable for diagnosis, characterization, pre-surgical evaluation and follow-up. (author)

  8. False-Negative Results of Endoscopic Biopsy in the Diagnosis of Gastrointestinal Kaposi’s Sarcoma in HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Naoyoshi Nagata

    2012-01-01

    Full Text Available Kaposi’s sarcoma (KS is a rare endothelial neoplasm mainly involving the skin, but it is often associated with AIDS. Diagnosis of gastrointestinal (GI tract KS, a common site of visceral involvement in AIDS, is important, but endoscopic biopsy carries a risk of false-negative results (FNRs due to its submucosal appearance. This study sought to determine the rate and causes of FNR for endoscopic biopsy of GI-KS lesions. Endoscopic biopsy samples of 116 GI-KS lesions were reviewed retrospectively. All GI-KS lesions were confirmed to be resolved following KS therapy. FNRs were yielded for 41 of the lesions (35.3%. Among upper and lower GI sites, the esophagus was the only site significantly associated with FNRs (P<0.01. Small size (<10 mm and patches found on endoscopy were significantly associated with FNRs (P<0.05. Findings of submucosal tumor (SMT with ulceration were significantly associated with true-positive results (P<0.05. In conclusion, FNRs were found in 35.3% of GI-KS lesions and were especially related to the site of the esophagus and endoscopic early stage (small size or patch appearance. An SMT with ulceration may be relatively easy to diagnose on endoscopic biopsy. Caution should be exercised when performing endoscopic biopsy of these lesions in AIDS patients and evaluating the histological features.

  9. Colonoscopia com magnificação de imagem no diagnóstico de carcinoma colorretal invasivo da submucosa na polipose adenomatosa familiar Magnifying colonoscopy diagnosis of submucosal invasive colorectal carcinoma in familial adenomatous polyposis

    Directory of Open Access Journals (Sweden)

    Cláudio TARTA

    2000-04-01

    lesions in the colon and rectum: laterally spreading tumor in the cecum, with IIIL + IV pits, subpediculate polyp in the transverse colon with approximately 2,0 cm diameter and IV + V pits, flat elevated lesions IIIL type, and in the sigmoid colon IIa + IIc lesion with V type of Kudo's classification were observed. The evaluation of pit patterns of the lesions in the transverse and sigmoid colon has enable to do the endoscopic diagnosis of the lesion with submucosal invasion.

  10. Tumors in invertebrates

    OpenAIRE

    Tascedda, F; Ottaviani, E.

    2014-01-01

    Tumors are ectopic masses of tissue formed by due to an abnormal cell proliferation. In this review tumors of several invertebrate species are examined. The description of tumors in invertebrates may be a difficult task, because the pathologists are usually inexperienced with invertebrate tissues, and the experts in invertebrate biology are not familiar with the description of tumors. As a consequence, the terminology used in defining the tumor type is related to that used in mammalian pathol...

  11. Tumor angiogenic factor and human skin tumors.

    Science.gov (United States)

    Wolf, J E; Hubler, W R

    1975-03-01

    A transparent acrylic hamster cheek-pouch chamber was used to investigate the elaboration of a tumor angiogenic factor (TAF) by human cutaneous neoplasms; direct tumor implantations, transfilter diffusion, and soluble tumor extracts were used in the study. A diffusible and filterable TAF was extracted from cutaneous tumors and produced distinctive patterns of sequential vasodilatation, tortuosity, and neovascular proliferation in the cheek-pouch membrane. Malignant human neoplasms (eg, melanoma, basal cell epithelioma, squamous cell carcinoma, lymphoma) produced striking neovascularization; vascular tumors (eg, Kaposi sarcoma, pyogenic granuloma, vascular histiocytoma) stimulated dramatic hyperemia and ectasia. Angiogenesis was conspicuously absent after implantation of control materials and nevoid or normal cutaneous components (with the exception of epidermis). Tumor angiogenic factor appears to induce direct stimulation of endothelial cell mitosis and may be essential for survival of nutritionally ravenous neoplastic tissues. The interference with TAF has therapeutic implications.

  12. Minimally invasive surgery for resection of duodenal carcinoid tumors: endoscopic full-thickness resection under laparoscopic observation.

    Science.gov (United States)

    Tsujimoto, Hironori; Ichikura, Takashi; Nagao, Shigeaki; Sato, Tomoki; Ono, Satoshi; Aiko, Satoshi; Hiraki, Shuichi; Yaguchi, Yoshihisa; Sakamoto, Naoko; Tanimizu, Takemaru; Yamamoto, Junji; Hase, Kazuo

    2010-02-01

    Carcinoid tumors of the duodenum are rare, and the most effective treatment for duodenal carcinoid tumors remains debatable. Because carcinoid tumors of the gastrointestinal tract tend to spread to the submucosal layer even during the early stages of the disease, the possibility of tumor seeding in the vertical margin of the tumor cannot be eliminated by conventional endoscopic mucosal resection (EMR). In addition, because the duodenal wall is thinner than the gastric wall, EMR performed for duodenal lesions may be associated with a high risk of accidental perforation. In this article, we introduce a minimally invasive endoscopic full-thickness resection technique after laparoscopic repair for the local resection of duodenal carcinoid tumors. Under general anesthesia, after the duodenum was mobilized laparoscopically, the duodenal serosa at the site of the lesion was suctioned under laparoscopic observation, and full-thickness resection of the duodenum was performed using a cap-fitted endoscope, i.e., EMR-c, without injecting hypertonic saline-epinephrine. The sample was retrieved endoscopically after resection. After confirming that the full-thickness resection of the duodenal wall with enough surgical margins was achieved and that there was no active bleeding, the wound was sutured by the laparoscopic hand-suturing technique. We have performed this surgical procedure in two cases of duodenal carcinoid tumor. The mean operation time was 116 +/- 14 minutes, and the estimated blood loss was 2.5 +/- 0.5 ml. The postoperative courses were uneventful in both cases. The technique of endoscopic full-thickness resection of gastrointestinal tract under laparoscopic observation is a safe, simple, and can be radical surgical procedure for a small duodenal carcinoid tumor. This surgical procedure may be applicable in the case of other gastrointestinal tumors.

  13. A Case of a Gastrointestinal Stromal Tumor with Skeinoid Fibers of the Sigmoid Colon

    Directory of Open Access Journals (Sweden)

    Tetsuo Sumi

    2014-09-01

    Full Text Available An 80-year-old man was diagnosed with rectal cancer and underwent Hartmann's procedure. Although no tumors were identified during the preoperative examination, gross examination of the resected specimen incidentally revealed a submucosal tumor that was 9 mm in diameter at the oral side and located in the proximal stump of the specimen from the sigmoid colon. We suspected a concurrent gastrointestinal stromal tumor (GIST and performed a histopathological examination. An L-shaped nodular lesion measuring 9 × 6 mm was histologically composed of a patternless proliferation of spindle cells intermingled with eosinophilic globules. Cellular atypia, prominent mitotic figures and necrotic foci were not observed in the nodule. The spindle cells were positive for CD34, CD117 and vimentin, but negative for CD56, smooth muscle actin and S-100 protein. MIB-1 positivity was estimated to be as low as approximately 1-2%. Electron microscopy showed a bundle of wool-like fibers with a periodicity of approximately 40 nm. We therefore considered the lesion to be a low-risk GIST with skeinoid fibers in the large intestine. Although numerous previous reports have reported skeinoid fibers in the stomach and small intestines, there have been only 9 cases (including the present case of skeinoid fibers in the large intestine.

  14. Esophageal Granular Cell Tumor and Eosinophilic Esophagitis: Two Interesting Entities Identified in the Same Patient

    Directory of Open Access Journals (Sweden)

    Alfredo J. Lucendo

    2008-02-01

    Full Text Available We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients.

  15. RELATIONSHIP BETWEEN PARAMETERS OF TUMOR NEOANGIOGENESIS AND LYMPHOGENOUS METASTASIS IN PATIENTS WITH RECTAL CANCER

    Directory of Open Access Journals (Sweden)

    I. V. Stepanov

    2017-01-01

    Full Text Available Angiogenesis (neoangiogenesis characterized by the formation of new blood vessels from pre-existing vessels is the main condition for the intensive growth of the primary tumor. This process is characterized by a sequence of events beginning with vasodilation, separation of pericytes from the vascular wall with subsequent proliferation of endotheliocytes and formation of vascular glomeruli surrounded by stromal cells. Evaluation of the density of microvessels, as well as «vascular kidneys» (clusters of endotheliocytes is the most widely used method for quantifying intracellular angiogenesis. The purpose of the study was to analyze the expression characteristics of markers of neoangiogenesis (CD34 and VEGFR in tumor tissue and to evaluate their relationship with the parameters of lymphogenous metastasis in colorectal cancer. Material and methods. Surgical specimens from 130 patients with ypT1–4N0–2M0 stage of rectal cancer, who were treated at the Thoracic and Abdominal Department of Tomsk Cancer Research Institute, were analyzed. The standard techniques for histological and immunohistochemical examinations were used. Diagnose was made according to WHO classification (2010. The study included only cases with rectal adenocarcinoma. Results. When studying the density of microvessels and «vascular budding» in a tumor tissue using an antibody to CD34, it turned out that the density of microvessels in the submucosal layer of the rectum was higher in cases with the presence of lymphogenous metastases than in cases without lymphogenous metastasis. The microvessel density determined by the antibody to VEGFR in the mucosa, submucosal and muscle layers, as well as in the serosa of the rectum did not differ between groups with the presence or absence of lymphogenous metastases. The density of «vascular kidneys» in all layers of the rectum wall was not associated with lymphogenous metastasis. Conclusion. The study showed that the expression of

  16. Morphological change of a laterally spreading rectal tumor over a short period.

    Science.gov (United States)

    Miyamoto, Hideaki; Oono, Yasuhiro; Fu, Kuang-l; Ikematsu, Hiroaki; Fujii, Satoshi; Kojima, Takashi; Yano, Tomonori; Ochiai, Atsushi; Sasaki, Yutaka; Kaneko, Kazuhiro

    2013-08-19

    Laterally spreading tumors (LSTs) are generally defined as superficial lesions ≥10 mm in diameter that typically extend laterally rather than vertically along the colonic wall. LSTs are usually categorized into 2 subtypes: granular type and nongranular type. Large nodules or depressed areas in granular-type LSTs (LST-Gs) are endoscopic findings of a cancerous component and sometimes represent submucosal invasion. However, the lateral growth and development of LST-Gs remains unclear. This case report describes a case of 79-year-old woman who underwent total colonoscopy due to a positive fecal occult blood test and was detected a LST-G, about 30 mm in diameter in the lower rectum. The lesion consisted of not only aggregated small and large nodules typically seen in LST-Gs but also the hardly elevated flat parts. In the flat part, there were dilated round pits and no evident capillary vessels. Three months later, the flat part increased in height, the dilated round pits were partly replaced by type IIIL pits, and capillary vessels were evident. The lesion was removed by endoscopic submucosal dissection, and diagnosed pathologically as tubular adenoma. We performed the sequence analyses on KRAS, BRAF, NRAS and PIK3CA genes in flat part and nodular part separately, and a mutation of KRAS gene at codon 146 was observed at only nodular part, suggesting probable that nodular part be a precancerous lesion. This is a unique and suggestive case, providing information on progression of LST-Gs at the very early stage to carcinogenesis.

  17. Novel strategy of endoscopic submucosal dissection using an insulation-tipped knife for early gastric cancer: near-side approach method

    Science.gov (United States)

    Mori, Genki; Nonaka, Satoru; Oda, Ichiro; Abe, Seiichiro; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Nakajima, Takeshi; Saito, Yutaka

    2015-01-01

    Background and study aims: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming. To eliminate these difficulties, we developed a novel strategy which we have called the “near-side approach method” and assessed its utility. Patients and methods: We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014. The technical results of ESD were compared between the group treated with the novel near-side approach method and the group treated with the conventional method. Results: This study included 238 patients with 238 lesions, 118 of which were removed using the near-side approach method and 120 of which were removed using the conventional method. The median procedure time was 92 minutes for the near-side approach method and 120 minutes for the conventional method. The procedure time was significantly shorter in the near-side approach method arm. Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes). Conclusions: The near-side approach method appears to require less time to complete gastric ESD than the conventional method using IT knives for technically challenging lesions located on the greater curvature of the gastric body, especially if the procedure is performed by less-experienced endoscopists. PMID:26528496

  18. The effect of sequential therapy with lansoprazole and ecabet sodium in treating iatrogenic gastric ulcer after endoscopic submucosal dissection: a randomized prospective study.

    Science.gov (United States)

    Ahn, Ji Yong; Choi, Chang Hwan; Lee, Jang Wook; Park, Sung Jin; Kim, Jeong Wook; Chang, Sae Kyung; Han, Seung Bong

    2015-02-01

    Ecabet sodium (ES) is a new non-systemic anti-ulcer agent belonging to the category of gastroprotective agents. In this study we aimed to compare the efficacy of a combination therapy with lansoprazole (LS) followed by ES with LS alone in treating endoscopic submucosal dissection (ESD)-induced iatrogenic gastric ulcers. Patients diagnosed with gastric adenomas or early gastric cancer were randomly divided into either the LS group (30 mg once daily for 4 weeks; n = 45) or the LS + ES group (LS 30 mg once daily for one week followed by ES 1500 mg twice daily for 3 weeks; n = 45). Four weeks after ESD, a follow-up endoscopy was conducted to evaluate the proportions of ulcer reduction and ulcer stages in the two groups. In all, 79 patients were included in the final analyses. Both treatment modalities were well-tolerated in most patients, with a drug compliance of over 80%. There were no significant differences between the two groups in terms of the proportions of ulcer reduction (0.9503 ± 0.1215 in the LS group vs 0.9192 ± 0.0700 in the LS + ES group, P = 0.169) or ulcer stage (P = 0.446). The prevalence of adverse events related to drugs and bleeding were also similar between the two groups. Sequential therapy with LS + ES is as effective as LS alone against ESD-induced gastric ulcers. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  19. Long-term outcome of endoscopic submucosal dissection is comparable to that of surgery for early gastric cancer: a propensity-matched analysis.

    Science.gov (United States)

    Jeon, Hye Kyung; Kim, Gwang Ha; Lee, Bong Eun; Park, Do Youn; Song, Geun Am; Kim, Dae Hwan; Jeon, Tae Yong

    2017-04-10

    Data concerning the long-term outcomes of endoscopic submucosal dissection (ESD) versus surgery for early gastric cancer (EGC) are limited. We aimed to compare the long-term outcomes of ESD and surgery for patients with EGC. Data were reviewed from patients treated by ESD or surgery for EGC in 2005-2010. The primary outcome was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), disease-free survival (DFS), recurrence-free survival (RFS), treatment-related complications, and hospital stay duration. Among 617 patients, 342 underwent ESD and 275 underwent surgery. The 5-year OS rates were similar between the ESD group and the surgery group (96.9% vs 98.1%, P = 0.581). In a propensity-score-matched analysis of 117 pairs, there were no significant differences in the OS rates (96.5% vs 99.1%, P = 0.125) and DSS rates (100% vs 99.1%, P = 0.317) between the ESD group and the surgery group. The ESD group had a significantly lower DFS rate (90.3% vs 98.0%, P = 0.002), a significantly lower RFS rate (95.1% vs 98.0%, P = 0.033), a significantly higher early complication rate (6.7% vs 1.5%, P comparable OS rates in patients with EGC. ESD has benefits, including a lower late complication rate and shorter hospital stay. However, RFS and DFS rates might be lower after ESD than after surgery.

  20. Prospective randomized controlled trial to compare the effects of omeprazole and famotidine in preventing delayed bleeding and promoting ulcer healing after endoscopic submucosal dissection.

    Science.gov (United States)

    Tomita, Toshihiko; Kim, Yongmin; Yamasaki, Takahisa; Okugawa, Takuya; Kondo, Takashi; Toyoshima, Fumihiko; Sakurai, Jun; Tanaka, Junji; Morita, Tsuyoshi; Oshima, Tadayuki; Fukui, Hirokazu; Hori, Kazutoshi; Watari, Jiro; Matsumoto, Takayuki; Miwa, Hiroto

    2012-09-01

    Proton pump inhibitors (PPIs) are generally used to prevent delayed bleeding after endoscopic submucosal dissection (ESD) and to heal the artificial ulcers. However, it remains controversial whether PPIs or histamine-2 receptor antagonists (H(2) RAs) are more effective in preventing delayed bleeding after ESD. We prospectively compared the effects of omeprazole and famotidine in preventing delayed bleeding and promoting artificial ulcer healing after ESD. A total of 158 patients (155 early gastric cancers and three adenomas) were randomly assigned to the PPI group (omeprazole 20 mg/day) or H(2) RA group (famotidine 40 mg/day) in a prospective randomized controlled trial. The primary end point was the incidence of hematemesis, melena, and/or a decrease in hemoglobin level of 2 g/dL or more requiring endoscopic hemostatic treatment. ESD-induced ulcer healing and changes in ulcer size were also compared at 6 weeks after ESD as a secondary end point. Of the 158 patients, two were excluded from analysis because they had been treated with a PPI before the present study. Accordingly, data from 77 PPI and 79 H(2) RA subjects were included for analysis. Delayed bleeding after ESD occurred in 6.5% of subjects (PPI group) and in 6.3% (H(2) RA group); there was no significant difference between the two groups. Likewise, the two groups were not significantly different with respect to ulcer stage or ulcer size reduction rate. Proton pump inhibitors are not superior to H(2) RAs for the prevention of delayed bleeding or the healing of artificially induced ulcers after ESD. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

  1. Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study.

    Science.gov (United States)

    Hatta, Waku; Gotoda, Takuji; Oyama, Tsuneo; Kawata, Noboru; Takahashi, Akiko; Yoshifuku, Yoshikazu; Hoteya, Shu; Nakagawa, Masahiro; Hirano, Masaaki; Esaki, Mitsuru; Matsuda, Mitsuru; Ohnita, Ken; Yamanouchi, Kohei; Yoshida, Motoyuki; Dohi, Osamu; Takada, Jun; Tanaka, Keiko; Yamada, Shinya; Tsuji, Tsuyotoshi; Ito, Hirotaka; Hayashi, Yoshiaki; Nakamura, Tomohiro; Nakaya, Naoki; Shimosegawa, Tooru

    2017-10-05

    We have established a risk-scoring system, termed the "eCura system," for the risk stratification of lymph node metastasis in patients who have received noncurative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to clarify whether this system contributes to the selection of patients requiring radical surgery after ESD. Between 2000 and 2011, 1,969 patients with noncurative ESD for EGC were included in this multicenter study. Depending on the treatment strategy after ESD, we had patients with no additional treatment (n = 905) and those with radical surgery after ESD (n = 1,064). After the application of the eCura system to these patients, cancer recurrence and cancer-specific mortality in each risk category of the system were compared between the two patient groups. Multivariate Cox analysis revealed that in the high-risk category, cancer recurrence was significantly higher (hazard ratio = 3.13, p = 0.024) and cancer-specific mortality tended to be higher (hazard ratio = 2.66, p = 0.063) in patients with no additional treatment than in those with radical surgery after ESD, whereas no significant differences were observed in the intermediate-risk and low-risk categories. In addition, cancer-specific survival in the low-risk category was high in both patient groups (99.6 and 99.7%). A limitation of this study is that it included a small number of cases with undifferentiated-type EGC (292 cases). The eCura system is a useful aid for selecting the appropriate treatment strategy after noncurative ESD for EGC. However, caution is needed when applying this system to patients with undifferentiated-type EGC.

  2. Effectiveness of CO2-insufflated endoscopic submucosal dissection with the duodenal balloon occlusion method for early esophageal or gastric cancer: a randomized case control prospective study

    Directory of Open Access Journals (Sweden)

    Mori Hirohito

    2012-04-01

    Full Text Available Abstract Background Endoscopic submucosal dissection (ESD has typically been performed using air insufflation. Recently, however, insufflation of CO2 has been increasingly used to avoid complications. This prospective study was designed to compare the CO2 concentration, intestinal volume, and acid–base balance using the duodenal balloon procedure. Methods From June 2010 to February 2011, we enrolled 44 patients with esophageal or gastric cancer and randomly allocated them into two groups. We compared 22 patients undergoing CO2-insufflated ESD with a balloon placed into the duodenal bulb (duodenal balloon group and 22 patients undergoing regular CO2-insufflated ESD (regular group. Three-dimensional computed tomography was performed before and after the procedure to measure intestinal volume. CO2 concentrations were measured every 10 minutes. The visual analogue system (VAS scores for postoperative symptoms were recorded, and pH was measured immediately after the procedure. This was a prospective case control study randomized by the sealed envelope method. Results Intestinal CO2 gas volume before and after ESD was lower in the duodenal balloon group than in the regular group (P = 0.00027. The end-tidal CO2 level was significantly lower in the duodenal balloon group than in the regular group (P = 0.0001. No significant differences in blood ΔpH were found between the two groups. The VAS score for the occurrence of nausea due to abdominal distension after ESD indicated a significant difference (P = 0.031. Conclusions ESD using the duodenal balloon occlusion method is effective for reduction of post-ESD intestinal CO2 gas volume, resulting in a lower total amount of CO2 insufflation during ESD and reducing harmful influences on the human body to some extent.

  3. Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older.

    Science.gov (United States)

    Sumiyoshi, Tetsuya; Kondo, Hitoshi; Fujii, Ryoji; Minagawa, Takeyoshi; Fujie, Shinya; Kimura, Tomohiro; Ihara, Hideyuki; Yoshizaki, Naohito; Hirayama, Michiaki; Oyamada, Yumiko; Okushiba, Shunichi

    2017-05-01

    Only a few studies have reported long-term outcomes for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) in elderly patients. The aim of this study was to evaluate the efficacy of ESD for EGC in elderly patients ≥75 years with respect to both short- and long-term outcomes. We reviewed the clinical data of elderly patients ≥75 years who had undergone ESD for EGC at Tonan Hospital from January 2003 to May 2010. A total of 177 consecutive patients, including 145 with curative resection (CR) and 32 with noncurative resection (non-CR), were examined. Of the 32 patients with non-CR, 15 underwent additional surgery, and lymph node metastases were found in 3 patients. The remaining 17 patients were followed without additional surgery because of advanced age or poor general condition. Procedure-related complications, such as post-ESD bleeding, perforation and pneumonia, were within the acceptable range. The 5-year survival rates of patients with CR, those with additional surgery after non-CR, and those without additional surgery after non-CR were 84.6, 73.3, and 58.8 %, respectively. No deaths were attributable to the original gastric cancer; patients succumbed to other illnesses, including malignancy and respiratory disease. In elderly patients, ESD is an acceptable treatment for EGC in terms of both short- and long-term outcomes. Careful clinical assessment of elderly patients is necessary before ESD. After ESD, medical follow-up is important so that other malignancies and diseases that affect the elderly are not overlooked.

  4. Endoscopic submucosal dissection for gastric cancer in elderly Japanese patients: an observational study of financial costs of treatment based on a national administrative database.

    Science.gov (United States)

    Murata, Atsuhiko; Muramatsu, Keiji; Ichimiya, Yukako; Kubo, Tatsuhiko; Fujino, Yoshihisa; Matsuda, Shinya

    2014-02-01

    There is currently little information on the medical economic outcomes of endoscopic submucosal dissection (ESD) for gastric cancer (GC) in elderly patients. This study therefore aimed to investigate the medical economic outcomes of ESD in elderly patients with GC using a national administrative database. A total of 27 385 patients treated with ESD for GC were referred to 867 hospitals in Japan from 2009 to 2011. We collected data from the national administrative database and divided them into two groups according to age: elderly patients (≥80 years; n = 5525) and non-elderly patients (<80 years; n = 21 860). We compared ESD-related complications, risk-adjusted length of stay (LOS) and medical costs during hospitalization between elderly and non-elderly patients. There was no significant difference in ESD-related complications between elderly and non-elderly patients (4.3% vs 3.9%, P = 0.152). However, significant differences were observed in mean LOS and medical costs during hospitalization between the two groups (P < 0.001). Multiple linear regression analysis showed that elderly patients experienced a significantly longer LOS and higher medical costs. The unstandardized coefficient for LOS in elderly patients was 2.71 days (95% confidence interval [CI] 2.59-2.84, P < 0.001), while that for medical costs during hospitalization was USD952.1 (95% CI 847.7-1056.5, P < 0.001). LOS and medical costs during hospitalization were significantly higher in elderly patients undergoing ESD for GC than in non-elderly patients, although there was no difference in the incidence of ESD-related complications. © 2013 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  5. Extraosseous calcifying epithelial odontogenic tumor (Pindborg tumor).

    Science.gov (United States)

    Wertheimer, F W; Zielinski, R J; Wesley, R K

    1977-10-01

    A 20-year-old man presented with a painless enlargement of the maxillary gingiva with no bone involvement. Microscopic examination with special stains confirmed the diagnosis of a clear cell variant of a calcifying epithelial odontogenic tumor (Pindborg tumor). This is the second reported case of such a variant in an extraosseous location.

  6. Bronchial carcinoid tumors: A rare malignant tumor

    African Journals Online (AJOL)

    2015-02-03

    Feb 3, 2015 ... Nigerian Journal of Clinical Practice • Sep-Oct 2015 • Vol 18 • Issue 5. Abstract. Bronchial carcinoid tumors (BCTs) are an uncommon group of lung tumors. They commonly affect the young adults and the middle aged, the same age group affected by other more common chronic lung conditions such as ...

  7. Spinal tumors in children.

    Science.gov (United States)

    Joaquim, Andrei Fernandes; Ghizoni, Enrico; Valadares, Marcelo Gomes Cordeiro; Appenzeller, Simone; Aguiar, Simone Dos Santos; Tedeschi, Helder

    2017-05-01

    Spinal tumors are rare in the pediatric population, presenting many specific peculiarities when compared to adults. We have performed a broad narrative review to describe the most common spinal tumors in children, discussing their main characteristics and management options. The authors have performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Multimodality radiological studies (plain films, 3D computed tomography scan and magnetic resonance imaging) are necessary for proper evaluation and differential diagnosis of spinal tumors in children. In selected cases nuclear medicine imaging is used to improve the chances of a more accurate diagnosis. As a general rule, a fine needle biopsy is recommended after radiological evaluation to confirm the tumor's histology. Primary bone tumors can be divided into benign bone tumors, mostly represented by vertebral hemangiomas, osteoid osteomas, osteoblastomas, aneurismal bone cysts, and eosinophilic granulomas, and malign or aggressive tumors, such as Ewing's or osteogenic sarcomas. Secondary bone tumors (spinal metastases) comprise different tumor histologies, and treatment is mainly based on tumor's radiosensitivity. The characteristics and treatment options of the main spinal tumors are discussed in details. Spinal tumors in children are rare lesions that demand a thorough understanding of their main characteristics for their proper management. Understanding the nuances of spinal tumors in children is of paramount importance for improving outcomes and chances of cure.

  8. Spinal tumors in children

    Directory of Open Access Journals (Sweden)

    Andrei Fernandes Joaquim

    Full Text Available Summary Introduction: Spinal tumors are rare in the pediatric population, presenting many specific peculiarities when compared to adults. We have performed a broad narrative review to describe the most common spinal tumors in children, discussing their main characteristics and management options. Method: The authors have performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results: Multimodality radiological studies (plain films, 3D computed tomography scan and magnetic resonance imaging are necessary for proper evaluation and differential diagnosis of spinal tumors in children. In selected cases nuclear medicine imaging is used to improve the chances of a more accurate diagnosis. As a general rule, a fine needle biopsy is recommended after radiological evaluation to confirm the tumor's histology. Primary bone tumors can be divided into benign bone tumors, mostly represented by vertebral hemangiomas, osteoid osteomas, osteoblastomas, aneurismal bone cysts, and eosinophilic granulomas, and malign or aggressive tumors, such as Ewing's or osteogenic sarcomas. Secondary bone tumors (spinal metastases comprise different tumor histologies, and treatment is mainly based on tumor's radiosensitivity. The characteristics and treatment options of the main spinal tumors are discussed in details. Conclusion: Spinal tumors in children are rare lesions that demand a thorough understanding of their main characteristics for their proper management. Understanding the nuances of spinal tumors in children is of paramount importance for improving outcomes and chances of cure.

  9. Salivary gland tumors

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001040.htm Salivary gland tumors To use the sharing features on this page, please enable JavaScript. Salivary gland tumors are abnormal cells growing in the gland ...

  10. Children's Brain Tumor Foundation

    Science.gov (United States)

    ... 2 Family Donate Volunteer Justin's Hope Fund Children’s Brain Tumor Foundation, A non-profit organization, was founded ... and the long term outlook for children with brain and spinal cord tumors through research, support, education, ...

  11. Metaphyseal giant cell tumor

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    Pereira, L.F.; Hemais, P.M.P.G.; Aymore, I.L.; Carmo, M.C.R. do; Cunha, M.E.P.R. da; Resende, C.M.C.

    Three cases of metaphyseal giant cell tumor are presented. A review of the literature is done, demostrating the lesion is rare and that there are few articles about it. Age incidence and characteristics of the tumor are discussed.

  12. Metastatic brain tumor

    Science.gov (United States)

    ... JavaScript. A metastatic brain tumor is cancer that started in another part of the body ... of cancer rarely spread to the brain, such as colon cancer and prostate cancer. In other rare cases, a tumor can ...

  13. Aggressive malignant phyllodes tumor

    OpenAIRE

    Nathan Roberts; Dianne M. Runk

    2015-01-01

    Introduction: Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3–0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumo...

  14. Huge intrathoracic desmoid tumor

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    Ibrahim Majdi

    2009-01-01

    Full Text Available Desmoid tumors are soft-tissue neoplasms arising from fascial or musculo-aponeurotic structures. Most reported thoracic desmoid tumors originate from the chest wall. However, intrathoracic desmoid tumors are rare. We present a case of a 35-year-old male patient complaining of mild shortness of breath. The patient was diagnosed to have a huge intrathoracic desmoid tumor, which was successfully resected.

  15. GASTROENTEROPANCREATIC NEUROENDOCRINE TUMORS ...

    African Journals Online (AJOL)

    INTRODUCTION. Neuroendocrine tumors comprise heterogeneous group of neoplasms which originate from endocrine cells, both within endocrine organs and within the cells of diffuse endocrine system. These tumors have vari- able clinical behavior ranging from well-differentiated, slow growing tumors to ...

  16. Granular Cell Tumor

    African Journals Online (AJOL)

    ultrastructure and immunochemical staining. 4 strongly suggest Schwann cell derivation . hyperplasia at the edges of the tumor. Necrosis within the tumor was absent, no mitosis was. Granular cell tumors are seldom diagnosed identified in the section and the edges of the accurately clinically. The lesion in this case was.

  17. Tumores de la conjuntiva Conjunctiva tumors

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    Clara G Gómez Cabrera

    2004-06-01

    Full Text Available Con el objetivo de conocer los tumores de la conjuntiva más frecuentes en este medio, se realizó un estudio descriptivo retrospectivo de 202 pacientes operados Hospital Oftalmológico "Ramón Pando Ferrer" con diagnóstico histológico de tumores conjuntivales, en el período comprendido entre enero de 1985 y diciembre de 1995; 116 pacientes (57 % fueron del sexo masculino y 86 (43 % del sexo femenino. El 30 % se encontraba en el grupo de edades entre los 31 y 50 años. El 61,9 % de las lesiones se localizaba en la conjuntiva bulbar. Se obtuvo un total de 17 diagnósticos histológicos. Los tumores de la conjuntiva se observaron con mayor frecuencia entre los 31 y lo 50 años de edad. El sexo masculino fue el más afectado en nuestra serie. Se localizan preferentemente en la conjuntiva bulbar. Los tumores más frecuentes fueron los pterigion, los nevus y los granulomasTo know the most frequent conjunctiva tumors in our setting, a descriptive retrospective study of 202 patients with histological diagnosis of conjunctival tumors, who underwent surgery at "Ramón Pando Ferrer" Ophthalmological Hospital from January 1985 to December 1995, was made. One hundred and sixteen patients (57 % were males and 86 (43 % were females. 30 % were in the age group 31-50. 61.9 % of the injuries were located in the bulbar conjunctiva. It was obtained a total of 17 histological diagnoses. The conjunctiva tumors were more frequently observed in patients aged 31-50. Males were the most affected in our series. These tumors are preferably located in the bulbar conjunctiva. The most common tumors were pterygion, nevus and granulomas

  18. Calcifying epithelial odontogenic tumor (Pindborg tumor).

    Science.gov (United States)

    Singh, Neeraj; Sahai, Sharad; Singh, Sourav; Singh, Smita

    2011-07-01

    The calcifying epithelial odontogenic tumor (CEOT) is a rare entity and represents less than 1% of all odontogenic tumors. Dr. J J Pindborg (1958) first described four cases of this unusual lesion; subsequently Shafer et al coined the term Pindborg tumor. This lesion is a locally aggressive benign odontogenic neoplasm arising from epithelial tissue. It occurs most commonly in 4(th)-5(th)-6(th) decade of life and bears no gender predilection. A case of CEOT in a 50-year-old male arising in the left body region is described.

  19. Tumor penetrating peptides

    Directory of Open Access Journals (Sweden)

    Tambet eTeesalu

    2013-08-01

    Full Text Available Tumor-homing peptides can be used to deliver drugs into tumors. Phage library screening in live mice has recently identified homing peptides that specifically recognize the endothelium of tumor vessels, extravasate, and penetrate deep into the extravascular tumor tissue. The prototypic peptide of this class, iRGD (CRGDKGPDC, contains the integrin-binding RGD motif. RGD mediates tumor homing through binding to αv integrins, which are selectively expressed on various cells in tumors, including tumor endothelial cells. The tumor-penetrating properties of iRGD are mediated by a second sequence motif, R/KXXR/K. This C-end Rule (or CendR motif is active only when the second basic residue is exposed at the C-terminus of the peptide. Proteolytic processing of iRGD in tumors activates the cryptic CendR motif, which then binds to neuropilin-1 activating an endocytic bulk transport pathway through tumor tissue. Phage screening has also yielded tumor-penetrating peptides that function like iRGD in activating the CendR pathway, but bind to a different primary receptor. Moreover, novel tumor-homing peptides can be constructed from tumor-homing motifs, CendR elements and protease cleavage sites. Pathologies other than tumors can be targeted with tissue-penetrating peptides, and the primary receptor can also be a vascular zip code of a normal tissue. The CendR technology provides a solution to a major problem in tumor therapy, poor penetration of drugs into tumors. The tumor-penetrating peptides are capable of taking a payload deep into tumor tissue in mice, and they also penetrate into human tumors ex vivo. Targeting with these peptides specifically increases the accumulation in tumors of a variety of drugs and contrast agents, such as doxorubicin, antibodies and nanoparticle-based compounds. Remarkably the drug to be targeted does not have to be coupled to the peptide; the bulk transport system activated by the peptide sweeps along any compound that is

  20. Tumor interstitial fluid

    DEFF Research Database (Denmark)

    Gromov, Pavel; Gromova, Irina; Olsen, Charlotta J.

    2013-01-01

    Tumor interstitial fluid (TIF) is a proximal fluid that, in addition to the set of blood soluble phase-borne proteins, holds a subset of aberrantly externalized components, mainly proteins, released by tumor cells and tumor microenvironment through various mechanisms, which include classical...... into the regulatory mechanisms and functions of secretion-related processes in tumor development. Secondly, the anomalous secretion of molecules that is innate to tumors and the tumor microenvironment, being associated with cancer progression, offers a valuable source for biomarker discovery and possible targets...... for therapeutic intervention. Here we provide an overview of the features of tumor-associated interstitial fluids, based on recent and updated information obtained mainly from our studies of breast cancer. Data from the study of interstitial fluids recovered from several other types of cancer are also discussed...

  1. Pulmonary neuroendocrine (carcinoid) tumors

    DEFF Research Database (Denmark)

    Caplin, M E; Baudin, E; Ferolla, P

    2015-01-01

    BACKGROUND: Pulmonary carcinoids (PCs) are rare tumors. As there is a paucity of randomized studies, this expert consensus document represents an initiative by the European Neuroendocrine Tumor Society to provide guidance on their management. PATIENTS AND METHODS: Bibliographical searches were...... carried out in PubMed for the terms 'pulmonary neuroendocrine tumors', 'bronchial neuroendocrine tumors', 'bronchial carcinoid tumors', 'pulmonary carcinoid', 'pulmonary typical/atypical carcinoid', and 'pulmonary carcinoid and diagnosis/treatment/epidemiology/prognosis'. A systematic review...... of the relevant literature was carried out, followed by expert review. RESULTS: PCs are well-differentiated neuroendocrine tumors and include low- and intermediate-grade malignant tumors, i.e. typical (TC) and atypical carcinoid (AC), respectively. Contrast CT scan is the diagnostic gold standard for PCs...

  2. Single fixed-time artificial insemination in gilts and weaned sows using pLH at estrus onset administered through vulvar submucosal route.

    Science.gov (United States)

    Ulguim, R R; Fontana, D L; Bernardi, M L; Wentz, I; Bortolozzo, F P

    2016-09-01

    This study evaluated the use of a single fixed-time artificial insemination (FTAI) in gilts and weaned sows using 2.5 mg of porcine luteinizing hormone (pLH) administered through vulvar submucosal route, at the onset of estrus. In experiment 1 (Exp.1), 318 pubertal gilts were assigned to two groups: control-G-no hormonal application and artificial inseminations (AIs) at 12, 36, and 60 hours after the onset of estrus if they were still in standing estrus; and FTAI-G-use of pLH at the onset of estrus and a single FTAI 12 hours later. In experiment 2 (Exp. 2), 309 weaned sows were assigned to three groups: Control-S-no hormone application and AIs at 0, 24, and 48 hours after the onset of estrus if they were still in standing estrus; FTAI-NH-no hormone application and a single FTAI at 24 hours after the onset of estrus, and FTAI-pLH-use of pLH at the onset of estrus and a single FTAI 24 hours later. Transabdominal real time B-mode ultrasonography was performed to determine whether the insemination had been performed within 24 hours before ovulation, considered as the optimal interval. In Exp. 1, ultrasound evaluation (12-hour intervals) was carried out to determine the interval between the onset of estrus and ovulation. In both experiments, 2 × 10(9) sperm cells in 80 mL were used to perform cervical and postcervical deposition of semen in gilts and sows, respectively. Compared with control-G, FTAI-G gilts had shorter (P gilts inseminated within the optimal interval. In Exp. 2, there were no differences in the AFR (Control-S: 94.1%; FTAI-NH: 86.1%; FTAI-pLH: 88.0%) and TPB (Control-S: 12.8; FTAI-NH: 12.7, and FTAI-pLH: 12.0 piglets) among treatments. The presence of semen backflow reduced (P gilts, but a single FTAI performed 12 hours later reduces the farrowing rate. A single FTAI performed at 24 hours after the onset of estrus in weaned sows does not affect their reproductive performance, regardless of pLH application. Copyright © 2016 Elsevier Inc. All

  3. Anxiety control of dental patients by clinical combination of acupuncture, Bi-Digital O-Ring Test, and eye movement desensitization with sedation via submucosal route.

    Science.gov (United States)

    Lu, Dominic P; Lu, Gabriel P; Lu, Winston I

    2007-01-01

    The data presented in this article was collected after reviewing clinical findings gathered from using various anxiety control methods on apprehensive patients. We examined clinical applications of the eye movement (EM) component of Eye Movement Desensitization (EMD) on fearful dental patients who have histories of traumatic dental experiences. We also used Bi-Digital O-Ring Test (BDORT) to select the proper dosage of sedative to minimize the adverse side effects. For patients who did not respond well to EM, we used BDORT to select the proper sedative medication and its dosage. In certain difficult cases, we supplemented these techniques with acupuncture to augment the sedative effects. Findings were based on the clinical impressions and assessments of both the patients and the operating team. Results showed that EM, although effective in enabling patients to undergo non-invasive dental procedures such as clinical examination and simple prophylaxis, had only limited beneficial effect with invasive procedures such as extraction, drilling, and injections, etc. We also found that BDORT greatly reduced adverse side effects of sedatives such as hypertension, hypotension, hypoxia, tachycardia, bradycardia, nausea, and vomiting. For most apprehensive patients, we found that EMD and acupuncture combined with BDORT predetermined dosage for the submucosal sedation enabled these patients to undergo the complete dental treatment. The authors try to explain the mechanism of BDORT and EM in terms of visual awareness (or consciousness) and preferred patterns, where neurons in the brain respond to the actions and/or direction of movement. The authors believe that BDORT and EM could have better results if the persons performing BDORT have visual awareness and are focused on the task; whereas in EM, the patient's eye on the therapist's hand movements. A more focused approach via visual pathway will result in more favorable results in EM. Likewise, performing BDORT absentmindedly

  4. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors.

    Science.gov (United States)

    Gincul, Rodica; Ponchon, Thierry; Napoleon, Bertrand; Scoazec, Jean-Yves; Guillaud, Olivier; Saurin, Jean-Christophe; Ciocirlan, Mihai; Lepilliez, Vincent; Pioche, Mathieu; Lefort, Christine; Adham, Mustapha; Pialat, Jean; Chayvialle, Jean-Alain; Walter, Thomas

    2016-11-01

    Background and study aim: As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and outcome of endoscopic treatment of duodenal NETs. Patients and methods: We reviewed the files of all patients who underwent endoscopic resection of a sporadic duodenal or ampullary NET between 1996 and 2014 at two centers. Results: A total of 29 patients with 32 uT1N0M0 NETs < 20 mm were included. Treatment consisted of endoscopic mucosal resection in 19 cases, and cap aspiration in 13 cases. Prior submucosal saline injection was used in 15 cases. Mortality was 3 % (one severe bleeding). Morbidity was 38 % (11/29). At post-resection analysis, mean tumor size was 8.9 mm (range 3 - 17 mm), 29 lesions were stage pT1, one was pT2, and 2 were pTx because of piecemeal resection. All NETs were well differentiated. A total of 27 lesions were classified as grade 1 and 5 were grade 2. The resection was R0, R1, and Rx for 16, 14, and 2 lesions, respectively. Three R1 patients underwent additional surgical treatment, with no residual tumor on the surgical specimen but with positive metastatic lymph nodes in two cases. One patient was lost to follow-up. Finally, 24 patients were included in the follow-up analysis. The median follow-up period was 56 months (range 6 - 175 months). Two patients presented a tumor recurrence during the follow-up period. Conclusions: Endoscopic treatment of small duodenal NETs was associated with significant morbidity, a difficulty in obtaining an R0 specimen, and the risk of lymph node metastasis. Nevertheless, it represents an interesting alternative in small grade 1 duodenal lesions and in patients at high surgical risk. © Georg Thieme Verlag KG Stuttgart · New York.

  5. [Tumor genetic heterogeneity].

    Science.gov (United States)

    Yang, Yi-Ling; Chu, Jia-You; Wang, Ming-Rong

    2013-01-01

    Although the majority of spontaneous tumors derive from a single cell, people have come to realize intra-tumor heterogeneity of individual tumors. Human cancers frequently display substantial difference in phenotypic features, such as the degree of differentiation, cell proliferation rate, invasion and metastatic potential, response to therapy and many other aspects. Molecular biology studies have confirmed the occurrence of new mutations during the process of tumor progression, which provide more powerful evidences to show the existence of intra-tumor genetic heterogeneity. This re-view will focus on recent major advances in the study of tumor genetic heterogeneity. Considering that genetic heterogene-ity analysis can provide important information to indicate how long normal cells transform into tumor cells and how to spread and migrate, we firstly describe experimental evidences of intra-tumor genetic heterogeneity. Then we discuss the research value of genetic diversity in the evolutionary history of human individual tumor, introduce the two modes of the genetic heterogeneity - cancer stem cell model and the clonal evolution model, and summarize the implications of in-tra-tumor heterogeneity studies in metastasis and therapy. In addition, the article presents the research methods of genetic heterogeneity, including specific gene and genome-wide level, pointing out their strengths and limitations.

  6. Pediatric genetic ocular tumors

    OpenAIRE

    Rouhani, Behnaz; Ramasubramanian, Aparna

    2014-01-01

    Pediatric genetic ocular tumors include malignancies like retinoblastoma and phakomatosis like neurofibromatosis, tuberous sclerosis, von Hippel-Lindau syndrome, and nevoid basal cell carcinoma syndrome. It is important to screen for ocular tumors both for visual prognosis and also for systemic implications. The phakomatosis comprise of multitude of benign tumors that are aysmptomatic but their detection can aid in the diagnosis of the syndrome. Retinoblastoma is the most common malignant int...

  7. CARCINOID TUMOR OF THE DUODENUM: a rare tumor at an unusual site. Case series from a single institution

    Directory of Open Access Journals (Sweden)

    Jaques WAISBERG

    2013-03-01

    Full Text Available Context Duodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated. Objective To analyze the clinicopathological characteristics of patients with resected duodenal carcinoids. Methods Twenty patients (12 females and 8 males were investigated. Their average age was 66.4 ± 5.8 years old (43 to 88 years old. The data corresponding to the clinical picture, diagnosis, treatment, and prognosis of patients with duodenal carcinoid tumors subjected to resection over a period of 18 years (1993-2011 were analyzed. Results The most common symptoms were dyspepsia (50% and epigastric pain (45% followed by weight loss (10% and vomiting (5%. Carcinoid syndrome was not observed in any patient. The lesion was located on the first part of the duodenum in 15 (75% patients, the second part in 4 (20% patients, and the third part in 1 (5% patient. The diagnosis of a carcinoid tumor was established through an endoscopic excision biopsy in 19 (95% patients and an histopathological examination of the surgical specimen in 1 (5% patient. The average tumor size was 1.1 cm ± 0.4 cm (0.3 cm to 6.0 cm. Nineteen (95% patients were initially treated by endoscopic resection of the duodenal lesion. One patient (5%, whose tumor was on the third part of the duodenum underwent a duodenectomy of the third and fourth duodenal parts and duodenojejunal anastomosis. The duodenal carcinoid resection margin was involved in four (20% patients. Four (20% patients were subjected to a partial gastrectomy to fully remove the lesion. The tumor was restricted to the submucosal layer in 16 (80% cases, and it penetrated into the muscular layer in 4 (20% cases. All patients exhibited positive chromogranin A, neuron-specific enolase, and/or synaptophysin immunostaining. The average duration of the follow-up period was 39.6 months (3 to 96 months. Twelve (60% of the 20 cases in this series are alive without any evidence of active

  8. Aggressive malignant phyllodes tumor.

    Science.gov (United States)

    Roberts, Nathan; Runk, Dianne M

    2015-01-01

    Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3-0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10-30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount. We present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31cm in diameter and weighed over 10kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office. Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. TUMORES ANEXIALES Y EMBARAZO

    OpenAIRE

    Tapia M.,Mauricio; Orellana H,Ricardo; Cisterna C,Patricio; Gazitúa P.,Raimundo; Sepúlveda A.,Rodrigo

    2005-01-01

    Objetivo: Evaluar la frecuencia de tumores anexiales en el embarazo, la histología tumoral y los resultados perinatales. Pacientes y método: Análisis retrospectivo de 33 pacientes con diagnóstico de tumor anexial y embarazo atendidas en el Servicio de Obstetricia del Hospital San Juan de Dios entre febrero de 2001 a julio de 2004. Resultados: La asociación tumor anexial y embarazo fue 1 en 424 embarazos. El tipo histológico más frecuente fue el cistoadenoma seroso (19,2%). La cirugía no alter...

  10. Adenomatoid odontogenic tumor, an uncommon tumor

    Directory of Open Access Journals (Sweden)

    K Vasudevan

    2012-01-01

    Full Text Available Here we report a case of adenomatoid odontogenic tumor (AOT in the maxilla in a young girl aged 14 years and its surgical management. We also review the literature and variations in the nomenclature and classifications of this interesting tumor. The review of literature gives an interesting picture regarding terminologies in the past and dilemma in classifying this tumor. The introduction of the name adenomatoid odontogenic tumour has resulted in the simpler and fruitful surgical management like enucleation and curettage with no reports of recurrences. In the past, similar lesion with the terminology like adeno ameloblastoma has resulted in unnecessary mutilating surgery. The conflicting views whether the lesion is being neoplasm or an anomalous hamartomatous growth is also being discussed.

  11. Tumor carcinoide apendicular Appendiceal carcinoid tumor

    Directory of Open Access Journals (Sweden)

    Julio Vázquez Palanco

    2008-12-01

    Full Text Available El objetivo de este trabajo fue dar a conocer un interesante caso de tumor carcinoide que se presentó con cuadro clínico de apendicitis aguda. El paciente fue un varón de 8 años de edad, al cual se realizó apendicectomía a causa de una apendicitis aguda. El resultado anatomopatológico confirmó un tumor de células endocrinas (argentafinoma, tumor carcinoide en el tercio distal del órgano, que infiltraba hasta la serosa, y apendicitis aguda supurada. El paciente fue enviado a un servicio de oncohematología para tratamiento oncoespecífico. Por lo inusual de estos tumores en edades tempranas y por lo que puede representar para el niño una conducta no consecuente, decidimos presentar este caso a la comunidad científica nacional e internacional. Es extremadamente importante el seguimiento de los pacientes con apendicitis aguda y de las conclusiones del examen histológico, por lo que puede representar para el niño una conducta inadecuada en una situación como esta.The objective of this paper was to make known an interesting case of carcinoid tumor that presented a clinical picture of acute appendicitis.The patient was an eight-year-old boy that underwent appendectomy due to an acute appendicitis. The anatomopathological report confirmed an endocrine cell tumor (argentaffinoma, carcinoid tumor in the distal third of the organ that infiltrated up to the serosa, and acute suppurative appendicitis. The patient was referred to an oncohematology service for oncospecific treatment. As it is a rare tumor at early ages, and taking into account what a inconsequent behavior may represent for the child, it was decided to present this case to the national and international scientific community. The follow-up of the patients with acute appendicitis and of the conclusions of the histological examination is extremely important considering what an inadequate conduct may represent for the child in a situation like this.

  12. Slug expression enhances tumor formation in a noninvasive rectal cancer model.

    Science.gov (United States)

    Camp, E Ramsay; Findlay, Victoria J; Vaena, Silvia G; Walsh, Jarret; Lewin, David N; Turner, David P; Watson, Dennis K

    2011-09-01

    Epithelial-to-mesenchymal transition (EMT) is a series of molecular changes allowing epithelial cancer cells to acquire properties of mesenchymal cells: increased motility, invasion, and protection from apoptosis. Transcriptional regulators such as Slug mediate EMT, working in part to repress E-cadherin transcription. We report a novel, noninvasive in vivo rectal cancer model to explore the role of Slug in colorectal cancer (CRC) tumor development. For the generation of DLD-1 cells overexpressing Slug (Slug DLD-1), a Slug or empty (Empty DLD-1) pCMV-3Tag-1 (kanamycin-resistant) vector was used for transfection. Cells were evaluated for Slug and E-cadherin expression, and cell migration and invasion. For the in vivo study, colon cancer cells (parental DLD-1, Slug DLD-1, empty DLD-1, and HCT-116) were submucosally injected into the posterior rectum of nude mice using endoscopic guidance. After 28 d, tumors were harvested and tissue was analyzed. Slug expression in our panel of colon cancer cell lines was inversely correlated with E-cadherin expression and enhanced migration/invasion. Slug DLD-1 cells demonstrated a 21-fold increased Slug and 19-fold decreased E-cadherin expression compared with empty DLD-1. Similarly, the Slug DLD-1 cells had significantly enhanced cellular migration and invasion. In the orthotopic rectal cancer model, Slug DLD-1 cells formed rectal tumors in 9/10 (90%) of the mice (mean volume = 458 mm(3)) compared with only 1/10 (10%) with empty DLD-1 cells. Slug mediates EMT with enhanced in vivo rectal tumor formation. Our noninvasive in vivo model enables researchers to explore the molecular consequences of altered genes in a clinically relevant rectal cancer in an effort to develop novel therapeutic approaches for patients with rectal cancer. Published by Elsevier Inc.

  13. Skull Base Tumors

    Science.gov (United States)

    Schulz-Ertner, Daniela

    In skull base tumors associated with a low radiosensitivity for conventional radiotherapy (RT), irradiation with proton or carbon ion beams facilitates a safe and accurate application of high tumor doses due to the favorable beam localization properties of these particle beams. Cranial nerves, the brain stem and normal brain tissue can at the same time be optimally spared.

  14. Vanishing tumor in pregnancy

    Directory of Open Access Journals (Sweden)

    M V Vimal

    2012-01-01

    Full Text Available A patient with microprolactinoma, who had two successful pregnancies, is described for management issues. First pregnancy was uneventful. During the second pregnancy, the tumor enlarged to macroprolactinoma with headache and blurring of vision which was managed successfully with bromocriptine. Post delivery, complete disappearance of the tumor was documented.

  15. Renal inflammatory myofibroblastic tumor

    DEFF Research Database (Denmark)

    Heerwagen, S T; Jensen, C; Bagi, P

    2007-01-01

    Renal inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue tumor of controversial etiology with a potential for local recurrence after incomplete surgical resection. The radiological findings in renal IMT are not well described. We report two cases in adults with a renal mass treated...

  16. Pseudoanaplastic tumors of bone

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Won-Jong [Uijongbu St. Mary Hospital, The Catholic University of Korea, Department of Orthopaedic Surgery, Gyunggido, 480-821 (Korea); Mirra, Joseph M. [Orthopaedic Hospital, Orthopedic Oncology, Los Angeles, California (United States)

    2004-11-01

    To discuss the concept of pseudoanaplastic tumors of bone, which pathologically show hyperchromatism and marked pleomorphism with quite enlarged, pleomorphic nuclei, but with no to extremely rare, typical mitoses, and to propose guidelines for their diagnosis. From a database of 4,262 bone tumors covering from 1971 to 2001, 15 cases of pseudoanaplastic bone tumors (0.35% of total) were retrieved for clinical, radiographic and pathologic review. Postoperative follow-up after surgical treatment was at least 3 years and a maximum of 7 years. There were eight male and seven female patients. Their ages ranged from 10 to 64 years with average of 29.7 years. Pathologic diagnoses of pseudoanaplastic variants of benign bone tumors included: osteoblastoma (4 cases), giant cell tumor (4 cases), chondromyxoid fibroma (3 cases), fibrous dysplasia (2 cases), fibrous cortical defect (1 case) and aneurysmal bone cyst (1 case). Radiography of all cases showed features of a benign bone lesion. Six cases, one case each of osteoblastoma, fibrous dysplasia, aneurysmal bone cyst, chondromyxoid fibroma, giant cell tumor and osteoblastoma, were initially misdiagnosed as osteosarcoma. The remaining cases were referred for a second opinion to rule out sarcoma. Despite the presence of significant cytologic aberrations, none of our cases showed malignant behavior following simple curettage or removal of bony lesions. Our observation justifies the concept of pseudoanaplasia in some benign bone tumors as in benign soft tissue tumors, especially in their late evolutionary stage when bizarre cytologic alterations strongly mimic a sarcoma. (orig.)

  17. Ewing tumors in infants

    NARCIS (Netherlands)

    van den Berg, Henk; Dirksen, Uta; Ranft, Andreas; Jürgens, Heribert

    2008-01-01

    Malignancies in infancy are extremely rare. Ewing tumors are hardly ever noted in these children. Since it is generally assumed that malignancies in infancy have an extremely poor outcome, we wanted to investigate whether this was also the case in Ewing tumors. We identified in the Munster data

  18. Atypically localized glomus tumors

    Directory of Open Access Journals (Sweden)

    Meric Ugurlar

    2016-12-01

    Conclusion: When a painful mass is found in the body, glomus tumors should be kept in mind. The consideration of symptoms, including pain, temperature sensitivity, point tenderness, and discoloration, common characteristics of glomus tumors, may aid diagnosis. [Hand Microsurg 2016; 5(3.000: 112-117

  19. Pediatric genetic ocular tumors.

    Science.gov (United States)

    Rouhani, Behnaz; Ramasubramanian, Aparna

    2014-12-01

    Pediatric genetic ocular tumors include malignancies like retinoblastoma and phakomatosis like neurofibromatosis, tuberous sclerosis, von Hippel-Lindau syndrome, and nevoid basal cell carcinoma syndrome. It is important to screen for ocular tumors both for visual prognosis and also for systemic implications. The phakomatosis comprise of multitude of benign tumors that are aysmptomatic but their detection can aid in the diagnosis of the syndrome. Retinoblastoma is the most common malignant intraocular tumor in childhood and with current treatment modalities, the survival is more than 95%. It is transmitted as an autosomal dominant fashion and hence the offsprings of all patients with the germline retinoblastoma need to be screened from birth. This review discusses the various pediatric genetic ocular tumors discussing the clinical manifestation, diagnosis and treatment.

  20. Endoscopic full-thickness resection of a lateral spreading rectal tumor after unplanned injection of dilute hyaluronic acid into the subserosal layer (with video).

    Science.gov (United States)

    Konuma, H; Fu, K I; Konuma, I; Ueyama, H; Takahashi, T; Ogura, K; Miyazaki, A; Watanabe, S

    2012-06-01

    A 74-year-old woman underwent colonoscopy for investigation of a liver tumor. A lateral spreading tumor of the non-granular type (LST-NG), 25 mm in diameter, was detected at the rectosigmoid junction. As magnifying image-enhanced colonoscopy suggested a tubulovillous adenoma, endoscopic mucosal resection (EMR) was chosen for removal of the LST-NG. The lesion was effectively and evenly lifted after injection of 0.4% hyaluronic acid diluted with glycerol in the ratio of 1:1. A small amount of indigo-carmine dye was also added for coloration of the plane of resection. The lesion was completely removed en bloc. Although a blue-colored layer was identified in the resection defect, a small amount of a whitish layer was detected above the blue layer. The muscle layer was clearly located on the underside of the resected polyp. A total of 14 endoclips were used to close the defect completely. The patient was successfully treated conservatively without surgery. Histology of the resected specimen showed that it contained a tubulovillous adenoma with the submucosal layer and both layers of the muscularis propria. The surgical margin was free of neoplastic change horizontally and vertically. To the best of our knowledge, this is the first case report of full-thickness resection associated with EMR after unplanned injection of dilute hyaluronic acid into the subserosal layer rather than the intended submucosal layer. We describe how to promptly recognize this complication during colonoscopy, in order to achieve immediate closure of the defect, with the identification of a "mirror target sign" on the colonic wall.

  1. Parallel evolution of tumor subclones mimics diversity between tumors

    DEFF Research Database (Denmark)

    Martinez, Pierre; Birkbak, Nicolai Juul; Gerlinger, Marco

    2013-01-01

    Intratumor heterogeneity (ITH) may foster tumor adaptation and compromise the efficacy of personalized medicines approaches. The scale of heterogeneity within a tumor (intratumor heterogeneity) relative to genetic differences between tumors (intertumor heterogeneity) is unknown. To address this, we...

  2. Epilepsy and brain tumors

    Science.gov (United States)

    ENGLOT, DARIO J.; CHANG, EDWARD F.; VECHT, CHARLES J.

    2016-01-01

    Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70–80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60–75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20–50% of patients with meningioma and 20–35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60–90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life. PMID:26948360

  3. Targeting the tumor microenvironment

    Energy Technology Data Exchange (ETDEWEB)

    Kenny, P.A.; Lee, G.Y.; Bissell, M.J.

    2006-11-07

    Despite some notable successes cancer remains, for the most part, a seemingly intractable problem. There is, however, a growing appreciation that targeting the tumor epithelium in isolation is not sufficient as there is an intricate mutually sustaining synergy between the tumor epithelial cells and their surrounding stroma. As the details of this dialogue emerge, new therapeutic targets have been proposed. The FDA has already approved drugs targeting microenvironmental components such as VEGF and aromatase and many more agents are in the pipeline. In this article, we describe some of the 'druggable' targets and processes within the tumor microenvironment and review the approaches being taken to disrupt these interactions.

  4. [Malignant cartilage tumors].

    Science.gov (United States)

    Geirnaerdt, M J; Hogendoorn, P C; Taminiau, A H; Bloem, J L

    1998-06-01

    Malignant cartilaginous tumors (chondrosarcomas) are, with a relative frequency of 20%, the second most common malignant tumors of bone after osteosarcoma. The diagnosis of chondrosarcoma can usually be made confidently based on combination of clinical information, radiographs, Gd-enhanced MR imaging, and histologic examination of a biopsy sample. The combination of these parameters is important because accuracy of histologic diagnosis is adversely affected by unrepresentative sampling of these usually large tumors. The prognosis of patients with chondrosarcoma becomes poorer with more axial location, higher histologic grade, larger tumor size and inadequate resection. By careful analysis of radiographs and Gd-enhanced MR imaging the radiologist has the ability to improve the management of patients with chondrosarcoma.

  5. Tumor estromal gastrointestinal

    Directory of Open Access Journals (Sweden)

    Rolando Mendívil

    2010-04-01

    Full Text Available Los tumores estromales gastrointestinales son los tumores mesenquimáticos más frecuentes. Se localizan con frecuencia en el estómago y sus manifestaciones clínicas son variadas. Presentamos el caso de una paciente de 57 años que ingresó por hemorragia digestiva de dos días de evolución. Los estudios de imagen demostraron un tumor en pared gástrica. La paciente fue sometida a resección quirúrgica del tumor y el diagnóstico definitivo se realizó utilizando marcadores CD117 y CD34. A pesar de que el tratamiento definitivo es la resección quirúrgica, se ha desarrollado nuevos modelos de tratamiento utilizando terapia molecular dirigida. Diversos estudios están llevándose a cabo en la actualidad y algunos muestran resultados prometedores.

  6. GASTROINTESTINAL STROMAL TUMOR (GIST

    Directory of Open Access Journals (Sweden)

    Luigi eTornillo

    2014-11-01

    Full Text Available Gastrointestinal stromal tumors are the most frequent mesenchymal tumors of the gastrointestinal tract. The discovery that these tumors, formerly thought of smooth muscle origin, are indeed better characterized by specific activating mutation in genes coding for the receptor tyrosine kinases CKIT and PDGFRA and that these mutations are strongly predictive for the response to targeted therapy with receptor tyrosine kinase inhibitors has made GISTs the typical example of the integration of basic molecular knowledge in the daily clinical activity. The information on the mutational status of these tumors is essential to predict (and subsequently to plan the therapy. As resistant cases are frequently wild-type, other possible oncogenic events, defining other entities, have been discovered (e.g. succinil dehydrogenase mutation/dysregulation, insuline growth factor expression, mutations in the RAS-RAF-MAPK pathway. The classification of disease must nowadays rely on the integration of the clinico-morphological characteristics with the molecular data.

  7. Brain Tumors and Fatigue

    Science.gov (United States)

    ... can help calm the mind. Meditation, guided imagery, music therapy, and yoga are just a few worth investigating. Home Donor and Privacy Policies Find Resources Disclaimer Donate Subscribe Login American Brain Tumor Association 8550 W. Bryn Mawr Ave. Ste ...

  8. Pituitary Tumors: Condition Information

    Science.gov (United States)

    ... not they spread beyond the pituitary gland: 2 Pituitary adenomas (pronounced ad-n-OH-muhz ) are benign, meaning ... tumors fall into this category. Despite being benign, pituitary adenomas can make the pituitary gland produce too much ...

  9. [Markers of brain tumors].

    Science.gov (United States)

    Fumagalli, R; Pezzotta, S; Bernini, F; Racagni, G

    1984-05-19

    Biological markers of tumors are compounds or enzymatic activities measurable in body fluids. Their presence or concentration must be linked to tumoral growth. The markers of the central nervous system tumors are detected in CSF. Alpha-feto-protein, carcinoembryonic antigen, human chorionic gonadotropin, adenohypophyseal peptide hormones, enzymes, etc., have found some application in the early diagnosis of leptomeningeal metastasis. Other applications involve the early detection and recurrency of primary brain tumors, as well as the evaluation of efficacy of their therapy. The tests based on the CSF content of desmosterol and polyamines have been studied extensively. Their rationale is discussed and specificity, sensitivity, efficiency and predictive value are considered. Experimental results concerning a new possible biochemical marker, based on CSF concentration of cyclic adenosine monophosphate, are reported.

  10. Spinal Cord Tumor

    Science.gov (United States)

    ... that may be more likely to affect the spine include breast, lung, prostate and multiple myeloma. Complications Both noncancerous and cancerous spinal tumors can compress the spinal cord and nerves, leading ...

  11. Primary hepatic carcinoid tumor

    Directory of Open Access Journals (Sweden)

    Gao Jinbo

    2011-11-01

    Full Text Available Abstract Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.

  12. Brain Tumor Surgery

    Science.gov (United States)

    ... tumor surgery include: Seizures Weakness Balance/coordination difficulties Memory or cognitive problems Spinal fluid leakage Meningitis Brain swelling Stroke Excess fluid in the brain Coma Death Recovery Time Recovery time depends on: The procedure performed. ...

  13. Brain Tumors - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Brain Tumors URL of this page: https://medlineplus.gov/languages/braintumors.html Other topics A-Z Expand Section ...

  14. Adrenocortical tumors in children

    Directory of Open Access Journals (Sweden)

    R.C. Ribeiro

    2000-10-01

    Full Text Available Childhood adrenocortical tumors (ACT are rare. In the USA, only about 25 new cases occur each year. In Southern Brazil, however, approximately 10 times that many cases are diagnosed each year. Most cases occur in the contiguous states of São Paulo and Paraná. The cause of this higher rate has not been identified. Familial genetic predisposition to cancer (p53 mutations and selected genetic syndromes (Beckwith-Wiedemann syndrome have been associated with childhood ACT in general but not with the Brazilian counterpart. Most of the affected children are young girls with classic endocrine syndromes (virilizing and/or Cushing. Levels of urinary 17-ketosteroids and plasma dehydroepiandrosterone sulfate (DHEA-S, which are abnormal in approximately 90% of the cases, provide the pivotal clue to a diagnosis of ACT. Typical imaging findings of pediatric ACT consist of a large, well-defined suprarenal tumor containing calcifications with a thin capsule and central necrosis or hemorrhage. The pathologic classification of pediatric ACT is troublesome. Even an experienced pathologist can find it difficult to differentiate carcinoma from adenoma. Surgery is the single most important procedure in the successful treatment of ACT. The role of chemotherapy in the management of childhood ACT has not been established although occasional tumors are responsive to mitotane or cisplatin-containing regimens. Because of the heterogeneity and rarity of the disease, prognostic factors have been difficult to establish in pediatric ACT. Patients with incomplete tumor resection or with metastatic disease at diagnosis have a dismal prognosis. In patients with localized and completely resected tumors, the size of the tumor has predictive value. Patients with large tumors have a much higher relapse rate than those with small tumors.

  15. Placental site trophoblastic tumor

    Directory of Open Access Journals (Sweden)

    Jean eBouquet De Jolinière

    2014-08-01

    Full Text Available Trophoblastic tumors of placental site (PSTT are rare. They represent a rare form of gestational trophoblastic disease. (GTD. They occur mainly in women who have a history of miscarriage, termination of pregnancy, or even a normal or pathological ongoing pregnancy. The clinical course is unpredictable. This malignancy has different characteristics from other gestational trophoblastic tumors.Following a clinical case that we encountered and treated, we conducted a literary research and review, focusing primarily on prognostic factors and treatment.

  16. Pituitary tumors containing cholecystokinin

    DEFF Research Database (Denmark)

    Rehfeld, J F; Lindholm, J; Andersen, B N

    1987-01-01

    We found small amounts of cholecystokinin in the normal human adenohypophysis and therefore examined pituitary tumors from 87 patients with acromegaly, Cushing's disease, Nelson's syndrome, prolactinoma, or inactive pituitary adenomas. Five adenomas associated with Nelson's syndrome contained......'s disease and 7 acromegaly with adenomas containing ACTH. The cholecystokinin peptides from the tumors were smaller and less sulfated than cholecystokinin from normal pituitary glands. We conclude that ACTH-producing pituitary cells may also produce an altered form of cholecystokinin....

  17. Upper urinary tract tumors

    DEFF Research Database (Denmark)

    Gandrup, Karen L; Nordling, Jørgen; Balslev, Ingegerd

    2014-01-01

    of invasive and non-invasive tumors in ureter and renal pelvis based on the enhancement measured with Hounsfield Units. PURPOSE: To examine the value of CTU using split-bolus technique to distinguish non-invasive from invasive urothelial carcinomas in the upper urinary tract. MATERIAL AND METHODS: Patients......, but the examination is useful to diagnose a tumor in the renal pelvis and the ureter....

  18. Perlecan and tumor angiogenesis

    DEFF Research Database (Denmark)

    Jiang, Xinnong; Couchman, John R

    2003-01-01

    Perlecan is a major heparan sulfate proteoglycan (HSPG) of basement membranes (BMs) and connective tissues. The core protein of perlecan is divided into five domains based on sequence homology to other known proteins. Commonly, the N-terminal domain I of mammalian perlecan is substituted with thr...... have unwanted promoting effects on tumor cell proliferation and tumor angiogenesis. Understanding of these attributes at the molecular level may offer opportunities for therapeutic intervention....

  19. Risk factors for early metachronous tumor development after endoscopic resection for early gastric cancer.

    Directory of Open Access Journals (Sweden)

    Jae Yong Park

    Full Text Available Metachronous gastric tumor (MGT is one of major concerns after endoscopic submucosal dissection (ESD for early gastric cancer (EGC. Optimal follow-up strategy has not been yet well-established. The aim of this study was to identify the different clinical features of the patients according to the time interval to development of MGT.Among 1,780 consecutive patients with EGC who underwent ESD between 2005 and 2014, 115 patients with MGT were retrospectively reviewed. MGT was defined as secondary gastric cancer or dysplasia detected > 1 year after initial ESD. Clinicopathological factors associated with early development of MGT were evaluated.The median interval to development of MGT was 37 months. In univariate analysis, the median interval to MGT was shorter if EGC lesion was non-elevated type (39.4 vs 57.0 months, p = 0.011, or synchronous primary lesion was absent (39.8 vs 51.4 months, p = 0.050. In multivariate Cox's proportional hazards analysis, the hazard ratios for early occurrence of MGT were 1.966 (95% CI: 1.141-3.386, p = 0.015 and 1.911 (95% CI: 1.163-3.141, p = 0.011, respectively. There was no significant difference in overall survival after diagnosis of MGT between the early occurrence group and the late occurrence group.Non-elevated gross type and absence of synchronous gastric tumor were independent risk factors for early development of MGT. Meticulous endoscopic inspection is especially important for the detection of MGT during the early follow-up period in patients with these initial tumor characteristics.

  20. [Case study: a calcified epithelial odontogenic tumor (Pindborg tumor)].

    Science.gov (United States)

    Withofs, D; Neyt, L; Abeloos, J; De Clercq, C; Mommaerts, M

    1992-09-01

    The calcifying epithelial odontogenic tumor is a benign but locally aggressive tumor. Occasionally the term Pindborg tumor is used after the Danish pathologist who first described this tumor as an entity. The clinical feature is most commonly a slow-growing painless swelling. The tumor may show considerable roentgenographic variation. Usually this tumor shows characteristic histological features. Some variants can mimic malignant neoplasms. The invasive nature is not so obvious as that of an ameloblastoma, nevertheless it has to be treated in the same way. A long follow-up period is indicated since recurrence can occur after many years. A patient with a characteristic Pindborg tumor is presented.

  1. Imaging of soft tissue tumors

    National Research Council Canada - National Science Library

    Schepper, A. M. A. de; Vanhoenacker, F; Parizel, P. M; Gielen, Jacques

    2006-01-01

    ... studies. The scientific value of the BSTNR increased with the installation of a peer-review group of pathologists, all of whom shared a large amount of experience in soft tissue tumor pathology. They reviewed the pathological findings of all malignant tumors, all exceptional tumors, and all tumors in which there was a discordance between...

  2. Tumores neonatales bucomaxilofaciales Neonatal buccomaxillofacial tumors

    Directory of Open Access Journals (Sweden)

    Zoila del S. López Díaz

    2007-12-01

    Full Text Available Se realiza un estudio descriptivo, lineal y retrospectivo por un período de 10 años, de 11 recién nacidos (edad 0-30 días, quienes al nacer presentan en la región bucomaxilofacial un tumor que les ocasiona de manera determinante compromiso para la ventilación y/o alimentación, por lo que se hace necesario realizarles a todos de manera inmediata, tratamiento quirúrgico para preservarles la vida. Se analizaron las variables edad, sexo, color de la piel, diagnóstico, tumoraciones que se presentaron con mayor frecuencia, compromiso para la ventilación y/o alimentación, procederes y mortalidad. Los datos se recogieron en una planilla confeccionada al efecto, lo que permitió establecer resultados y confeccionar tablas. Se concluye que en nuestro estudio este tipo de tumoración afectó con mayor frecuencia al sexo femenino y a niños de piel blanca; y el tipo de tumoración observada con mayor frecuencia fueron las malformaciones vasculares de tipo linfático (linfangiomas gigantes o higromas quísticos, así como y los teratomas bucofaríngeos, con una mortalidad de alrededor del 27,3 % en estas edades neonatales.A descriptive, lineal and retrospective study of 11 newborn infants aged 0-30 days was conducted. They presented a tumor in the buccomaxillofacial region that compromised their ventilation and/or nutrition, which made necessary to immediately perform surgery to preserve their lives. The following variables were analyzed: age, sex, colour of the skin, diagnosis, the most common tumours, compromise for ventilation and/or nutrition, procedures and mortality. Data were collected in a form that allowed to establish results and to make tables. It was concluded that this type of tumor affected mostly females and white children. The most commonly observed tumors were vascular lymphatic malformations (giant lymphangiomas or cystic hygromas, as well as buccopharyngeal teratomas, with a mortality around 27.3 % at these neonatal ages.

  3. Metabolic Reprogramming in Brain Tumors.

    Science.gov (United States)

    Venneti, Sriram; Thompson, Craig B

    2017-01-24

    Next-generation sequencing has substantially enhanced our understanding of the genetics of primary brain tumors by uncovering several novel driver genetic alterations. How many of these genetic modifications contribute to the pathogenesis of brain tumors is not well understood. An exciting paradigm emerging in cancer biology is that oncogenes actively reprogram cellular metabolism to enable tumors to survive and proliferate. We discuss how some of these genetic alterations in brain tumors rewire metabolism. Furthermore, metabolic alterations directly impact epigenetics well beyond classical mechanisms of tumor pathogenesis. Metabolic reprogramming in brain tumors is also influenced by the tumor microenvironment contributing to drug resistance and tumor recurrence. Altered cancer metabolism can be leveraged to noninvasively image brain tumors, which facilitates improved diagnosis and the evaluation of treatment effectiveness. Many of these aspects of altered metabolism provide novel therapeutic opportunities to effectively treat primary brain tumors.

  4. Pituitary gland tumors; Hypophysentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Jesser, J.; Schlamp, K.; Bendszus, M. [Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Neuroradiologie, Heidelberg (Germany)

    2014-10-15

    This article gives an overview of the most common tumors of the pituitary gland and the differential diagnostics with special emphasis on radiological diagnostic criteria. A selective search of the literature in PubMed was carried out. Pituitary adenomas constitute 10-15 % of all intracranial tumors and are the most common tumors of the sellar region. Tumors smaller than 1 cm in diameter are called microadenomas while those larger than 1 cm in diameter are called macroadenomas. Approximately 65 % of pituitary gland adenomas secrete hormones whereby approximately 50 % secrete prolactin, 10 % secrete growth hormone (somatotropin) and 6 % secrete corticotropin. Other tumors located in the sella turcica can also cause endocrinological symptoms, such as an oversecretion of pituitary hormone or pituitary insufficiency by impinging on the pituitary gland or its stalk. When tumors spread into the space cranial to the sella turcica, they can impinge on the optic chiasm and cause visual disorders. A common differential diagnosis of a sellar tumor is a craniopharyngeoma. In children up to 10 % of all intracranial tumors are craniopharyngeomas. Other differential diagnoses for sellar tumors are metastases, meningiomas, epidermoids and in rare cases astrocytomas, germinomas or Rathke cleft cysts As these tumors are located in an anatomically complex region of the skull base and are often very small, a highly focused imaging protocol is required. The currently favored modality is magnetic resonance imaging (MRI) with the administration of a contrast agent. The sellar region should be mapped in thin slices. In cases of suspected microadenoma the imaging protocol should also contain a sequence with dynamic contrast administration in order to assess the specific enhancement characteristics of the tumor and the pituitary gland. (orig.) [German] Diese Arbeit ist eine Uebersicht ueber die haeufigsten Hypophysentumoren und deren Differenzialdiagnosen mit Augenmerk auf die

  5. Tumor de Pindborg (tumor odontogénico epitelial calcificante Pindborg tumor (Calcifying epithelial odontogenic tumor

    Directory of Open Access Journals (Sweden)

    J. Rubio Palau

    2007-10-01

    Full Text Available El objetivo del presente artículo es realizar una revisión de la literatura del tumor de Pindborg a propósito de un caso. El interés radica en su baja frecuencia y a la importancia de la anatomía patológica para su diagnóstico y correcto tratamiento ya que puede confundirse en algunos casos con otras tumoraciones benignas, a diferencia de las cuales, en este tumor debe realizarse una resección con márgenes de seguridad para disminuir la probabilidad de recidiva.The aim of this article is to review the literature on Pindborg tumor based on a case. In view of its low frequency and the importance of histology for its correct diagnosis and treatment as it can be confused with other benign tumors, appropriate resection is necessary with tumor-free margins in order to reduce the probability of local recurrence.

  6. CNS Tumors in Neurofibromatosis.

    Science.gov (United States)

    Campian, Jian; Gutmann, David H

    2017-07-20

    Neurofibromatosis (NF) encompasses a group of distinct genetic disorders in which affected children and adults are prone to the development of benign and malignant tumors of the nervous system. The purpose of this review is to discuss the spectrum of CNS tumors arising in individuals with NF type 1 (NF1) and NF type 2 (NF2), their pathogenic etiologies, and the rational treatment options for people with these neoplasms. This article is a review of preclinical and clinical data focused on the treatment of the most common CNS tumors encountered in children and adults with NF1 and NF2. Although children with NF1 are at risk for developing low-grade gliomas of the optic pathway and brainstem, individuals with NF2 typically manifest low-grade tumors affecting the cranial nerves (vestibular schwannomas), meninges (meningiomas), and spinal cord (ependymomas). With the identification of the NF1 and NF2 genes, molecularly targeted therapies are beginning to emerge, as a result of a deeper understanding of the mechanisms underlying NF1 and NF2 protein function. As we enter into an era of precision oncology, a more comprehensive awareness of the factors that increase the risk of developing CNS cancers in affected individuals, coupled with a greater appreciation of the cellular and molecular determinants that maintain tumor growth, will undoubtedly yield more effective therapies for these cancer predisposition syndromes.

  7. Epilepsy-related brain tumors.

    Science.gov (United States)

    Ertürk Çetin, Özdem; İşler, Cihan; Uzan, Mustafa; Özkara, Çiğdem

    2017-01-01

    Seizures are among the most common presentations of brain tumors. Several tumor types can cause seizures in varying rates; neuroglial tumors and the gliomas are the most common ones. Brain tumors are the second most common cause of focal intractable epilepsy in epilepsy surgery series, with the highest frequency being dysembryoplastic neuroepithelial tumors and gangliogliomas. Seizure management is an important part of the treatment of patients with brain tumors. This review discusses clinical features and management of seizures in patients with brain tumors, including, neuroglial tumors, gliomas, meningioma and metastases; with the help of recent literature data. Tumor-related seizures are focal seizures with or without secondary generalization. Seizures may occur either as initial symptom or during the course of the disease. Brain tumors related epilepsy tends to be resistant to antiepileptic drugs and treatment of tumor is main step also for the seizure treatment. Early surgery and extent of the tumor removal are important factors for achieving seizure freedom particularly in neuroglial tumors and low grade gliomas. During selection of the appropriate antiepileptic drug, the general approach to partial epilepsies can be followed. There are several factors influencing epileptogenesis in brain tumor-related epilepsy which also explains clinical heterogeneity of epilepsy among tumor types. Identification of molecular markers may guide future therapeutic approaches and further studies are needed to prove antitumor effects of different antiepileptic drugs. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  8. Dysembryoplastic Neuroepithelial Tumors

    Directory of Open Access Journals (Sweden)

    Yeon-Lim Suh

    2015-11-01

    Full Text Available Dysembryoplastic neuroepithelial tumor (DNT is a benign glioneuronal neoplasm that most commonly occurs in children and young adults and may present with medically intractable, chronic seizures. Radiologically, this tumor is characterized by a cortical topography and lack of mass effect or perilesional edema. Partial complex seizures are the most common presentation. Three histologic subtypes of DNTs have been described. Histologically, the recognition of a unique, specific glioneuronal element in brain tumor samples from patients with medically intractable, chronic epilepsy serves as a diagnostic feature for complex or simple DNT types. However, nonspecific DNT has diagnostic difficulty because its histology is indistinguishable from conventional gliomas and because a specific glioneuronal element and/or multinodularity are absent. This review will focus on the clinical, radiographic, histopathological, and immunohistochemical features as well as the molecular genetics of all three variants of DNTs. The histological and cytological differential diagnoses for this lesion, especially the nonspecific variant, will be discussed.

  9. Benign notochordal cell tumors.

    Science.gov (United States)

    Martínez Gamarra, C; Bernabéu Taboada, D; Pozo Kreilinger, J J; Tapia Viñé, M

    2017-08-01

    Benign notochordal cell tumors (TBCN) are lesions with notochordal differentiation which affect the axial skeleton. They are characterized by asymptomatic or non-specific symptomatology and are radiologically unnoticed because of their small size, or because they are mistaken with other benign bone lesions, such as vertebral hemangiomas. When they are large, or symptomatic, can be differential diagnosis with metastases, primary bone tumors and chordomas. We present a case of a TBCN in a 50-year-old woman, with a sacral lesion seen in MRI. A CT-guided biopsy was scheduled to analyze the lesion, finding that the tumor was not clearly recognizable on CT, so the anatomical references of MRI were used to select the appropriate plane. The planning of the approach and the radio-pathological correlation were determinant to reach the definitive diagnosis. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Tumor Markers: An Overview

    Directory of Open Access Journals (Sweden)

    Ajay G Nayak

    2010-01-01

    Full Text Available Oral cancer is a potentially fatal disease that has been the bane of clinicians throughout the world. Though various modalities of management exist, early detection still provides the best hope for any cancer patient Advances in molecular diagnosis have led to a plethora of choices being available in the fight against cancer. Abnormal cellular products elucidated from malignant cells can be detected and measured in various body tissues and fluids and constitute tumor markers. The various clinical applications and their limitations are covered in the brief overview to help the oral medicine specialist understand the relevant advances made in the field of tumor markers.

  11. Tumor-induced osteomalacia

    Directory of Open Access Journals (Sweden)

    Pablo Florenzano

    2017-12-01

    Full Text Available Tumor-induced osteomalacia (TIO is a rare paraneoplastic syndrome clinically characterized by bone pain, fractures and muscle weakness. It is caused by tumoral overproduction of fibroblast growth factor 23 (FGF23 that acts primarily at the proximal renal tubule, decreasing phosphate reabsorption and 1α-hydroxylation of 25 hydroxyvitamin D, thus producing hypophosphatemia and osteomalacia. Lesions are typically small, benign mesenchymal tumors that may be found in bone or soft tissue, anywhere in the body. In up to 60% of these tumors, a fibronectin-1(FN1 and fibroblast growth factor receptor-1 (FGFR1 fusion gene has been identified that may serve as a tumoral driver. The diagnosis is established by the finding of acquired chronic hypophosphatemia due to isolated renal phosphate wasting with concomitant elevated or inappropriately normal blood levels of FGF23 and decreased or inappropriately normal 1,25-OH2-Vitamin D (1,25(OH2D. Locating the tumor is critical, as complete removal is curative. For this purpose, a step-wise approach is recommended, starting with a thorough medical history and physical examination, followed by functional imaging. Suspicious lesions should be confirmed by anatomical imaging, and if needed, selective venous sampling with measurement of FGF23. If the tumor is not localized, or surgical resection is not possible, medical therapy with phosphate and active vitamin D is usually successful in healing the osteomalacia and reducing symptoms. However, compliance is often poor due to the frequent dosing regimen and side effects. Furthermore, careful monitoring is needed to avoid complications such us secondary/tertiary hyperparathyroidism, hypercalciuria, and nephrocalcinosis. Novel therapeutical approaches are being developed for TIO patients, such as image-guided tumor ablation and medical treatment with the anti-FGF23 monoclonal antibody KRN23 or anti FGFR medications. The case of a patient with TIO is presented to

  12. Brain tumors; Hirntumoren

    Energy Technology Data Exchange (ETDEWEB)

    Langen, K.J. [Forschungszentrum Juelich (Germany). Inst. fuer Neurowissenschaften und Biophysik; Stoffels, G. [Duesseldorf Univ. (Germany). C. und O. Vogt Inst. fuer Hirnforschung

    2007-09-15

    Magnetic Resonance Tomography (MRT) is the method of choice for the diagnostics of cerebral gliomas, but the differentiation of tumour tissue from unspecific tissue changes is limited. Positron emission tomography (PET) and Single-Photon-Emission-Computed Tomography (SPECT) may offer relevant additional information which allows for a more accurate diagnostics in unclear situations. Especially, radiolabeled amino acids offer a better delineation of cerebral gliomas which allows an improved guidance of biopsy, planning of surgery and radiation therapy. Furthermore, amino acid imaging appears to be useful to differentiate tumor recurrence from unspecific posttherapeutic tissue, to predict the prognosis especially in low grade gliomas and to monitor the metabolic response during tumor therapy. (orig.)

  13. Tumor-induced osteomalacia.

    Science.gov (United States)

    Jan de Beur, Suzanne M

    2005-09-14

    Tumor-induced osteomalacia (TIO) is a rare paraneoplastic form of renal phosphate wasting that results in severe hypophosphatemia, a defect in vitamin D metabolism, and osteomalacia. This debilitating disorder is illustrated by the clinical presentation of a 55-year-old woman with progressive fatigue, weakness, and muscle and bone pain with fractures. After a protracted clinical course and extensive laboratory evaluation, tumor-induced osteomalacia was identified as the basis of her clinical presentation. In this article, the distinctive clinical characteristics of this syndrome, the advances in diagnosis of TIO, and new insights into the pathophysiology of this disorder are discussed.

  14. "Osseous tumors of the hand "

    Directory of Open Access Journals (Sweden)

    "Farzan M

    2002-08-01

    Full Text Available The majority of osseous tumors of the hand are benign. The surgeon who evaluates and treats osseous tumors of the hand has to be familiar with limb anatomy, tumor biology, various presentations of the tumors and the range of treatment possibilities and their limitations. Lesions in the hand more often present earlier in their course than those at other sites, just because they are more likely to superficial and easily noticed. A review of all cases of osseous tumors of the hand, seen by a hand surgeon over the last 10 years, at Imam Khomeini hospital was performed. Among 55 cases with osseous tumors of hand, 48 primary benign bone tumors, 3 primary malignant bone tumors, and 4 metastatic bone tumors were found. Enchondroma was the most common benign bone tumor followed by osteoid osteoma, osteoblastoma, aneurismal bone cyst, giant cell tumor, epidermoid cyst, and osteochondroma. There were two chondrosarcoma and one Ewing’s sarcoma as primary malignant bone tumors. Metastasis to the hand from colon, esophagus, and breast were also found. There were also two cases with Brown tumor secondary to hyperparathyroidism, we conclude that a variety of osseous tumors could occur in the hand, and usually they are benign. Although malignant neoplasms in the hand that arise from tissues other than the skin are very rare, the hand may be the site of distant breast, lung, kidney, esophagus, or colon adenocarcinoma metastases, most of which have a predilection for the distal phalanges.

  15. TumorHoPe: a database of tumor homing peptides.

    Directory of Open Access Journals (Sweden)

    Pallavi Kapoor

    Full Text Available Cancer is responsible for millions of immature deaths every year and is an economical burden on developing countries. One of the major challenges in the present era is to design drugs that can specifically target tumor cells not normal cells. In this context, tumor homing peptides have drawn much attention. These peptides are playing a vital role in delivering drugs in tumor tissues with high specificity. In order to provide service to scientific community, we have developed a database of tumor homing peptides called TumorHoPe.TumorHoPe is a manually curated database of experimentally validated tumor homing peptides that specifically recognize tumor cells and tumor associated microenvironment, i.e., angiogenesis. These peptides were collected and compiled from published papers, patents and databases. Current release of TumorHoPe contains 744 peptides. Each entry provides comprehensive information of a peptide that includes its sequence, target tumor, target cell, techniques of identification, peptide receptor, etc. In addition, we have derived various types of information from these peptide sequences that include secondary/tertiary structure, amino acid composition, and physicochemical properties of peptides. Peptides in this database have been found to target different types of tumors that include breast, lung, prostate, melanoma, colon, etc. These peptides have some common motifs including RGD (Arg-Gly-Asp and NGR (Asn-Gly-Arg motifs, which specifically recognize tumor angiogenic markers. TumorHoPe has been integrated with many web-based tools like simple/complex search, database browsing and peptide mapping. These tools allow a user to search tumor homing peptides based on their amino acid composition, charge, polarity, hydrophobicity, etc.TumorHoPe is a unique database of its kind, which provides comprehensive information about experimentally validated tumor homing peptides and their target cells. This database will be very useful in

  16. Aggressive malignant phyllodes tumor

    Directory of Open Access Journals (Sweden)

    Nathan Roberts

    2015-01-01

    Conclusion: Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.

  17. Persistent trophoblastic tumors

    Directory of Open Access Journals (Sweden)

    M. N. Tikhonovskaya

    2013-01-01

    Full Text Available Persistent trophoblastic tumors (PTT are the most common trofhoblastic tumors, which develop in women when proliferative trophoblastic activ- ity remains after evacuation of hydatidiform mole. The term persistent trophoblastic disease (PTD is also widely used in the world literature. When PTD develops, new tissue is often not obtained. PTD is defined as a plateau or rise of serum β-hCG concentrations in tree subsequent weekly blood samples for 2 consecutive weeks (1, 8, 15 measurement days, the detection of β-hCG rise 6 months after hydatidiform mole evacu- ation. β-hCG is a glycoprotein hormone produced by trophoblastic tissue and a key tumor marker of gestational trophoblastic disease (GTD with almost 100 % sensitivity and specificity. A persistent trophoblastic tumor may have the histological features of invasive hydatidiform mole, cho- riocarcinoma or rare forms of trophoblastic disease. PTD is a fatal disease, which occurs in women of reproductive age. PTT is nowadays typi- cally treated with chemotherapy according to international standards for GTD management. In the case of early identification and adequate treatment of PTT the cure rates approach 100 %.

  18. Targeting thapsigargin towards tumors

    DEFF Research Database (Denmark)

    Doan, Nhu Thi Quynh; Paulsen, Eleonora Sandholdt; Sehgal, Pankaj

    2015-01-01

    substrates for either prostate specific antigen (PSA) or prostate specific membrane antigen (PSMA) prodrugs were created, which selectively affect prostate cancer cells or neovascular tissue in tumors. One of the prodrug is currently tested in clinical phase II. The prodrug under clinical trial has been...

  19. Exploring tumor heterogeneity

    NARCIS (Netherlands)

    Fessler, E.

    2016-01-01

    Cancer is a heterogeneous disease, which is reflected both on the cellular and the population level. Advances in detection, diagnosis, and treatment of malignancies have increased survival time of cancer patients; yet, the heterogeneity observed within and between tumors complicates accurate

  20. Intraventricular solitary fibrous tumor

    Directory of Open Access Journals (Sweden)

    Yan-yang CHEN

    2015-10-01

    Full Text Available Background Solitary fibrous tumor (SFT is a mesenchymal neoplasm of specialized fibroblastic lineage, which frequently occurs in the subcutaneous and deep soft tissue of pleura,mediastinum, head and neck, extremities and trunk. Although most SFTs of the central nervous system (CNS are dural based, a small subset presents as intraventricular without dural connection. It is a diagnostic challenge for radiologists and histopathologists to differentiate intraventricular SFT from other lesions, such as intraventricular meningioma, synovial sarcoma and Schwannoma, because of the similarities in radiological and histological findings. Herein we describe one case of unusual intraventricular primary SFT in right lateral ventricle. The radiology and clinicopathology of this lesion, as well as its differential diagnosis are discussed. Methods The clinical data of one patient with intraventricular SFT occurring in right lateral ventricle was presented retrospectively. Gross totally resected mass was routinely paraffin embedded and stained with hematoxylin and eosin. Dako EnVision immunohistochemical staining system was used to detect antigen expressions, including vimentin (Vim, cytokeratin(CK, CD34, CD99, Bcl-2, epithelial membrane antigen (EMA, glial fibrillary acidic protein (GFAP, S-100 protein (S-100, smooth muscle actin (SMA and desmin (Des. Results A 50-year-old man presented with progressively aggravated headache for over 2 months. CT revealed a slightly high-density mass in trigone of right lateral ventricle. MRI showed an intraventricular mass with isointense signal on T1WI, and mixed hyperintensity and hypointensity signal with "black and white pattern" on T2WI. The mass revealed heterogeneous enhancement after gadolinium administration. Preoperative magnetic resonance angiography (MRA displayed a highly vascularized lesion with late and persistent enhancement. During surgery, the mass was grey-red, had no capsule and connected with choroid

  1. Calcifying epithelial odontogenic tumor (Pindborg tumor) case report.

    Science.gov (United States)

    Oikarinen, V J; Calonius, P E; Meretoja, J

    1976-08-01

    A 36-year-old woman was examined and treated for a rare odontogenic tumor in the mandible, the calcifying epithelial odontogenic tumor (CEOT), also known as the Pindborg tumor. The tumor extended from the left mandibular molar region to the right premolar area and had almost completely destroyed the bone in the anterior mandibular region. An orthopantomogram showed a multiloculated radiolucent lesion, with an unerupted tooth in the center surrounded by a radiopaque area. In addition, finely granular calcification was visible here and there in the tumor area. In the histologic examination the tumor tissue could be identified as calcifying epithelial odontogenic tumor. Under electron microscopy the fibrillar structure at the basal cell level suggested the presence of amyloid. The tumor was removed by enucleation with a collar of surrounding tissue. No signs of recurrence have been noted at follow-up examinations.

  2. An exceptional collision tumor: gastric calcified stromal tumor and ...

    African Journals Online (AJOL)

    An exceptional collision tumor: gastric calcified stromal tumor and pancreatic adenocarcinoma. Hicham Baba, Mohamed Elfahssi, Mohamed Said Belhamidi, Abderrahman Elhjouji, Ahmed Bounaim, Abdelmounaim Ait Ali, Khalid Sair, Aziz Zentar ...

  3. Circulating tumor cells

    Science.gov (United States)

    Raimondi, Cristina; Nicolazzo, Chiara; Gradilone, Angela; Giannini, Giuseppe; De Falco, Elena; Chimenti, Isotta; Varriale, Elisa; Hauch, Siegfried; Plappert, Linda; Cortesi, Enrico; Gazzaniga, Paola

    2014-01-01

    The hypothesis of the “liquid biopsy” using circulating tumor cells (CTCs) emerged as a minimally invasive alternative to traditional tissue biopsy to determine cancer therapy. Discordance for biomarkers expression between primary tumor tissue and circulating tumor cells (CTCs) has been widely reported, thus rendering the biological characterization of CTCs an attractive tool for biomarkers assessment and treatment selection. Studies performed in metastatic colorectal cancer (mCRC) patients using CellSearch, the only FDA-cleared test for CTCs assessment, demonstrated a much lower yield of CTCs in this tumor type compared with breast and prostate cancer, both at baseline and during the course of treatment. Thus, although attractive, the possibility to use CTCs as therapy-related biomarker for colorectal cancer patients is still limited by a number of technical issues mainly due to the low sensitivity of the CellSearch method. In the present study we found a significant discordance between CellSearch and AdnaTest in the detection of CTCs from mCRC patients. We then investigated KRAS pathway activating mutations in CTCs and determined the degree of heterogeneity for KRAS oncogenic mutations between CTCs and tumor tissues. Whether KRAS gene amplification may represent an alternative pathway responsible for KRAS activation was further explored. KRAS gene amplification emerged as a functionally equivalent and mutually exclusive mechanism of KRAS pathway activation in CTCs, possibly related to transcriptional activation. The serial assessment of CTCs may represent an early biomarker of treatment response, able to overcome the intrinsic limit of current molecular biomarkers represented by intratumor heterogeneity. PMID:24521660

  4. Testicular germ cell tumors.

    Science.gov (United States)

    Diamantopoulos, N; Kortsaris, A

    2010-01-01

    Testicular cancer is the most frequent solid tumor in young male adults and a disease with elusive pathogenesis. Germ cell tumors represent 95% of all testicular cancers. There was an increasing incidence of testicular germ cell tumors during the second half of the 20th century. Despite their increased incidence, mortality is lower than 10% and the cure rate has reached 95%. Epidemiology of the disease shows remarkable geographic and racial variation. Known risk factors and the increased incidence during the last 50 years have led to the development of the two prevalent theories for the pathogenesis of the disease, Henderson theory and Rajpertde Meyts and Skakkebaek theory. Appropriate diagnosis and staging of the disease are crucial for successful management. Testicular ultrasound, CT scans, histological examination and serum tumor markers should be utilized in order to stratify the patient correctly. Treatment strategy is chosen according to the patient stage and prognostic group stratification. "Fine tuning" is needed in order to find the balance between treatment, cure and toxicity. Despite progress in therapeutic management, cure rates for poor risk patients do not exceed 50%. These patients should be encouraged to participate in clinical trials. Long-term toxicity of testicular germ cell tumors' treatment is also another issue that should be kept in mind during follow-up of these patients. This disease became the model of "curable" cancer and gave hope for cure of metastatic malignant diseases in general, as only 400 patients die from this disease in USA annually. More progress will be made only through well-designed clinical trials.

  5. Mixed odontogenic tumor: ameloblastoma and calcifying epithelial odontogenic tumor.

    Science.gov (United States)

    Etit, Demet; Uyaroglu, Mehmet Ali; Erdogan, Nezahat

    2010-01-01

    Odontogenic tumors constitute a group of heterogeneous disease derived from epithelial, mesenchymal and/or ectomesenchymal elements. Ameloblastoma is the best known and the most frequent form of odontogenic tumors. Calcifying epithelial odontogenic tumor (CEOT), known as Pindborg tumor, is locally invasive lesion which has a characteristic amiloid deposition. Here a case of a peripheral ameloblastoma associated with CEOT is presented with clinical and morphological features.

  6. Rare and Challenging Tumor Entity: Phyllodes Tumor of the Prostate

    Directory of Open Access Journals (Sweden)

    Andreas Bannowsky

    2009-01-01

    Full Text Available Cystic epithelial-stromal tumors of the prostate are rare, with 82 cases reported in literature. These cases have been published under a variety of diagnoses, including phyllodes tumor and prostatic stromal proliferation of uncertain malignant potential as well as a malignant tumor called “prostatic stromal sarcoma”. We report a case of a 60-year-old man with the histological diagnosis of phyllodes tumor of the prostate in transurethral resection specimen.

  7. Epidemiological features of brain tumors

    Directory of Open Access Journals (Sweden)

    Živković Nenad

    2013-01-01

    Full Text Available Brain tumors account for 1.4% of all cancers and 2.4% of all cancer-related deaths. The incidence of brain tumors varies and it is higher in developed countries of Western Europe, North America, Australia and New Zealand. In Serbia, according to data from 2009, malignant brain tumors account for 2. 2 of all tumors, and from all cancer­related deaths, 3.2% is caused by malignant brain tumors. According to recent statistical reports, an overall incidence of brain tumors for benign and malignant tumors combined is 18.71 per 100,000 persons/year. The most common benign brain tumor in adults is meningioma, which is most present in women, and the most common malignant tumor is glioblastoma, which is most present in adult men. Due to high mortality, especially in patients diagnosed with glioblastoma and significant brain tumor morbidity, there is a constant interest in understanding its etiology in order to possibly prevent tumor occurrence in future and enable more efficient treatment strategies for this fatal brain disease. Despite the continuously growing number of epidemiological studies on possible factors of tumor incidence, the etiology remains unclear. The only established environmental risk factor of gliomas is ionizing radiation exposure. Exposure to radiofrequency electromagnetic fields via cell phone use has gained a lot of attention as a potential risk factor of brain tumor development. However, studies have been inconsistent and inconclusive, so more definite results are still expected.

  8. Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than 30 mm.

    Science.gov (United States)

    Fujii, Hiroyuki; Ishii, Eiji; Tochitani, Shinako; Nakaji, So; Hirata, Nobuto; Kusanagi, Hiroshi; Narita, Makoto

    2015-01-01

    In the expanded indications for endoscopic resection, Japanese guidelines for gastric cancer include differentiated cancers confined to the mucosa with an ulcer ulcer. The horizontal and vertical margins were negative for the tumor. We diagnosed thiscase as curative resection of expanded indication and followed this patient with endoscopy, abdominal ultrasonography (AUS) or enhanced computed tomography (CT) approximately every 6 months. After 17 months, lymph node metastasis was detected with AUS and CT and diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy in August 2011. Distal gastrectomy with D2 dissection was carried out in December 2011. Although it is low, the possibility of recurrence should be borne in mind after endoscopic treatment of early gastric cancer, despite its inclusion in the expanded indications for endoscopic resection. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  9. Ovarian Germ Cell Tumors Treatment

    Science.gov (United States)

    ... Fallopian Tube, & Primary Peritoneal Cancer Screening Research Ovarian Germ Cell Tumors Treatment (PDQ®)–Patient Version General Information About Ovarian Germ Cell Tumors Go to Health Professional Version Key ...

  10. Primary tumors of the patella

    National Research Council Canada - National Science Library

    Song, Mingzhi; Zhang, Zhen; Wu, Yuxuan; Ma, Kai; Lu, Ming

    2015-01-01

    The patella is an uncommon location for cancerous occurrence and development. The majority of tumors of the patella are benign, with a significant incidence of giant cell tumors and chondroblastoma...

  11. Tumor Biology and Microenvironment Research

    Science.gov (United States)

    Part of NCI's Division of Cancer Biology's research portfolio, research in this area seeks to understand the role of tumor cells and the tumor microenvironment (TME) in driving cancer initiation, progression, maintenance and recurrence.

  12. Neuroendocrine tumors of the pancreas.

    LENUS (Irish Health Repository)

    Davies, Karen

    2009-04-01

    Pancreatic endocrine tumors are rare neoplasms accounting for less than 5% of pancreatic malignancies. They are broadly classified into either functioning tumors (insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas) or nonfunctioning tumors. The diagnosis of these tumors is difficult and requires a careful history and examination combined with laboratory tests and radiologic imaging. Signs and symptoms are usually related to hormone hypersecretion in the case of functioning tumors and to tumor size or metastases with nonfunctioning tumors. Surgical resection remains the treatment of choice even in the face of metastatic disease. Further development of novel diagnostic and treatment modalities offers potential to greatly improve quality of life and prolong disease-free survival for patients with pancreatic endocrine tumors.

  13. Neuroendocrine tumors of the pancreas.

    LENUS (Irish Health Repository)

    Davies, Karen

    2012-02-01

    Pancreatic endocrine tumors are rare neoplasms accounting for less than 5% of pancreatic malignancies. They are broadly classified into either functioning tumors (insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas) or nonfunctioning tumors. The diagnosis of these tumors is difficult and requires a careful history and examination combined with laboratory tests and radiologic imaging. Signs and symptoms are usually related to hormone hypersecretion in the case of functioning tumors and to tumor size or metastases with nonfunctioning tumors. Surgical resection remains the treatment of choice even in the face of metastatic disease. Further development of novel diagnostic and treatment modalities offers potential to greatly improve quality of life and prolong disease-free survival for patients with pancreatic endocrine tumors.

  14. Leukocyte trafficking in tumor microenvironment.

    Science.gov (United States)

    Del Prete, Annalisa; Schioppa, Tiziana; Tiberio, Laura; Stabile, Helena; Sozzani, Silvano

    2017-08-01

    The tumor microenvironment consists of both malignant and non-malignant cells and a plethora of soluble mediators. Different types of tumors have specific tumor microenvironments characterized by distinct chemokines and chemotactic factors that influence leukocyte recruitment. The immune cell infiltrate continuously interacts with stroma cells and influence tumor growth. Emerging evidence suggests that the regulation of the composition and the metabolic state of tumor-associated leukocytes may represent a new promising intervention strategy. Here we summarize the current knowledge on the role of tumor-associated immune cells in tumor growth and dissemination, with a specific focus on the nature of the chemotactic factors responsible for their accumulation and activation in tumors. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Drugs Approved for Brain Tumors

    Science.gov (United States)

    ... Ask about Your Treatment Research Drugs Approved for Brain Tumors This page lists cancer drugs approved by the ... that are not listed here. Drugs Approved for Brain Tumors Afinitor (Everolimus) Afinitor Disperz (Everolimus) Avastin (Bevacizumab) Becenum ( ...

  16. Biopsy in Musculoskeletal Tumors

    Directory of Open Access Journals (Sweden)

    Mohammad Gharehdaghi

    2014-09-01

    Full Text Available Diagnosis of bone tumors is based on careful evaluation of clinical, imaging and a pathologic findings. So the biopsy of bone and soft tissue sarcomas is the final step in evaluation and a fundamental step in the diagnosis of the lesion. It should not be performed as a shortcut to diagnosis (1. The biopsy should be performed in order to confirm the diagnosis and differentiate among few diagnoses after careful staged studies. Real and artificial changes in imaging studies will be superimposed after performing biopsy, which may alter the interpretation if done after biopsy is taken (1. The correct management of a sarcoma depends on the accurate diagnosis. Inadequate, inapprppriate, or inaccurate non-representative biopsy leads to poorer outcome in terms of survivorship and limb salvage. An incorrect, unplanned incision and biopsy may unnecessarily contaminate uninvolved compartments which may convert a salvageable limb to amputation. Anatomic approach along with the proper biopsy techniques may lead to success or catastrophe. It is clear that in patients with inappropriate biopsy, the chance of the need to change the treatment to more radical than would originally be expected is significantly higher. Also it is more probable to need to  convert curative to palliative treatment and to require adjuvant radiotherapy in patients with inappropriate biopsies. Patients with sarcoma are best served by early referral to a specialized center where staged investigations and biopsy can be performed with minimal morbidity (3. Open biopsy is still considered the gold standard; however, recent studies suggest comparable results with percutaneous core needle biopsy. Our study on 103 consecutive CNB and open biopsy showed comparable results as well. Surgeons need to answer to two questions prior to performing a biopsy: 1-          Where is the best part of the lesion to be biopsied? 2-          What is the safest route without contaminating

  17. Pindborg tumor in an adolescent.

    Science.gov (United States)

    Akhtar, Kafil; Khan, Nazoora; Zaheer, Sufian; Sherwani, Rana; Hasan, Abrar

    2010-01-01

    Calcifying epithelial odontogenic tumor (Pindborg tumor), is a rare benign odontogenic neoplasm representing about 0.4-3% of all odontogenic tumors. This tumor more frequently affects adults in the age range of 20-60 years, with a peak incidence in the 5th decade of life. Calcifying epithelial odontogenic tumour has a much lower recurrence rate than ameloblastoma and malignant transformation, and metastasis is rare.

  18. Notch Signaling and Brain Tumors

    DEFF Research Database (Denmark)

    Stockhausen, Marie; Kristoffersen, Karina; Poulsen, Hans Skovgaard

    2011-01-01

    Human brain tumors are a heterogenous group of neoplasms occurring inside the cranium and the central spinal cord. In adults and children, astrocytic glioma and medulloblastoma are the most common subtypes of primary brain tumors. These tumor types are thought to arise from cells in which Notch...... and medulloblastoma. In this chapter we will cover the present findings of Notch signaling in human glioma and medulloblastoma and try to create an overall picture of its relevance in the pathogenesis of these tumors....

  19. Enhancing Tumor Penetration of Nanomedicines

    OpenAIRE

    Sun, Qingxue; Ojha, Tarun; Kiessling, Fabian; Lammers, Twan; Shi, Yang

    2017-01-01

    Tumor-targeted nanomedicines have been extensively applied to alter the drawbacks and enhance the efficacy of chemotherapeutics. Despite the large number of preclinical nanomedicine studies showing initial success, their therapeutic benefit in the clinic has been rather modest, which is partially due to the inefficient tumor penetration caused by tumor microenvironment (high density of cells and extracellular matrix, increased interstitial fluid pressure). Furthermore, tumor penetration of na...

  20. Parasellar dermoid tumor with intra-tumoral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Mamata, H.; Yanagimachi, N.; Matsuyama, S. [Department of Radiology I, Tokai University School of Medicine, Kanagawa (Japan); Matsumae, M.; Takamiya, Y.; Tsugane, R. [Department of Neurosurgery, Tokai University School of Medicine, Kanagawa (Japan)

    1998-12-01

    We report a case of parasellar dermoid tumor with intra-tumoral hemorrhage. It is rare for a dermoid tumor that hemorrhage was detected as high attenuation on the initial CT. In the present case, the tumor content included a little fat component and mostly cholesterin-rich fluid which resulted in extremely low signal intensity on T2-weighted and high signal on T1-weighted MR images. In addition to this, hemosiderin accumulation in the tumor could be the reason for low signal intensity on T2-weighted images. (orig.) With 3 figs., 19 refs.

  1. Notch Signaling and Brain Tumors

    DEFF Research Database (Denmark)

    Stockhausen, Marie; Kristoffersen, Karina; Poulsen, Hans Skovgaard

    2011-01-01

    Human brain tumors are a heterogenous group of neoplasms occurring inside the cranium and the central spinal cord. In adults and children, astrocytic glioma and medulloblastoma are the most common subtypes of primary brain tumors. These tumor types are thought to arise from cells in which Notch s...

  2. Tumor budding in colorectal carcinomas.

    Science.gov (United States)

    Sert Bektaş, Sevda; Inan Mamak, Gülsün; Cırış, Ibrahim Metin; Bozkurt, Kemal Kürşat; Kapucuoğlu, Nilgün

    2012-01-01

    In colorectal carcinomas, tumor budding has been defined as the presence of isolated single tumor cells or small cell clusters in the stroma at the invasive tumor margin. In this study, the relationship between tumor budding density at the invasive tumor margin and pathological parameters is investigated. Haematoxylin and eosin stained slides of 73 cases with colorectal carcinoma were retrospectively evaluated for the presence and intensity of tumor budding by 2 observers. After the specimens were assessed, the highest density of tumor budding area was counted in a microscopic field of x200. Cases were separated into 2 groups according to tumor budding density as low grade ( tumor invasion, histological grade, vascular invasion and lymph node involvement was investigated. Of the 73 colorectal carcinoma cases, 33 (45.2%) had low and 40 (54.8%) had high grade tumor budding density, respectively. There was a statistically significant relationship between high grade tumor budding density and histological grade (p=0.042), lymph node involvement (p=0.0001) and vascular invasion (p=0.0034). High grade tumor budding density is associated with aggressive phenotypical features in colorectal carcinoma.

  3. Adenomatoid odontogenic tumor

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Hyung Kyu [Department of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1983-11-15

    A 18-year-old man had a painless swelling in the right anterior portion of maxilla for 2 years. On radiographic examination, a radiolucent region that was not associated with an unerupted tooth was seen. Small scattered radiopaque foci were seen in the cystic lumen. At second case, a 16-year-old girl had a painless swelling in the anterior portion of maxilla for 3 years. On radio graphic examination, a radiolucent region that associated with an unerupted tooth was seen. Multiple scattered radiopaque foci were seen in the radiolucent cystic lumen. With the patient under local anesthesia, well encapsulated tumors were enucleated. The diagnosis made in the pathologist's report was Adenomatoid Odontogenic Tumor, benign lesion often having distinct clinical and radiographic features.

  4. Inflammatory myofibroblastic tumor

    Directory of Open Access Journals (Sweden)

    Sangeeta Palaskar

    2011-01-01

    Full Text Available Inflammatory myofibroblastic tumor is an uncommon lesion of unknown cause. It encompasses a spectrum of myofibroblastic proliferation along with varying amount of inflammatory infiltrate. A number of terms have been applied to the lesion, namely, inflammatory pseudotumor, fibrous xanthoma, plasma cell granuloma, pseudosarcoma, lymphoid hamartoma, myxoid hamartoma, inflammatory myofibrohistiocytic proliferation, benign myofibroblatoma, and most recently, inflammatory myofibroblastic tumor. The diverse nomenclature is mostly descriptive and reflects the uncertainty regarding true biologic nature of these lesions. Recently, the concept of this lesion being reactive has been challenged based on the clinical demonstration of recurrences and metastasis and cytogenetic evidence of acquired clonal chromosomal abnormalities. We hereby report a case of inflammatory pseudotumor and review its inflammatory versus neoplastic behavior.

  5. Retroperitoneal inflammatory myofibroblastic tumor

    Directory of Open Access Journals (Sweden)

    Bapsy Poonamalle P

    2005-10-01

    Full Text Available Abstract Background Inflammatory myofibroblastic tumor (IMT is a neoplasm of unknown etiology occurring at various sites. By definition, it is composed of spindle cells (myofibroblasts with variable inflammatory component, hence the name is IMT. Case presentation The present case is of a 46 years old woman presented with a history of flank pain, abdominal mass and intermittent hematuria for last 6 months. The initial diagnosis was kept as renal cell carcinoma. Finally, it turned out to be a case of retroperitoneal IMT. The patient was managed by complete surgical resection of the tumor. Conclusion IMT is a rare neoplasm of uncertain biological potential. Complete surgical resection remains the mainstay of the treatment.

  6. Calcifying epithelial odontogenic tumor of the maxilla (Pindborg tumor).

    Science.gov (United States)

    Müller, Danko; Manojlović, Spomenka; Luksić, Ivica; Grgurević, Jaksa

    2012-11-01

    Calcifying epithelial odontogenic tumor (CEOT), or the Pindborg tumor, is very rare neoplasm, which accounts up to 1% of all odontogenic tumors. These tumors involve mandible almost twice as common as the maxillary bone, mostly in the premolar and molar region and present at first with local swelling. There is no gender predilection and the tumor usually appears between 2nd and 6th decade of life. We report the case of a 36-year-old male patient with a Pindborg tumor in the maxillary region on the right side, also involving the adjacent maxillary sinus, with destroying of the local anatomical structures. Complete surgical excision of the tumor has been performed and four years after surgical treatment, there is no sign of recurrence.

  7. Large-sized kidney tumor mimicking an extraorgan retroperitoneal tumor

    Directory of Open Access Journals (Sweden)

    I. A. Reva

    2015-03-01

    Full Text Available The retroperitoneal space may be a site for a broad spectrum of both rare benign and malignant tumors that are in turn a focus of primary or metastatic involvement. Sarcomas, lymphomas, and different epithelial tumors (of the kidney, adrenal, and pancreas constitute the bulk of retroperitoneal tumors. Detection of a large-sized tumor located at one of the renal poles may raise the question of whether this mass is a kidney tumor or an extraorgan retroperitoneal tumor adjacent to or growing into the kidney. In view of significant differences in treatment procedures for various retroperitoneal tumors, when the origin of the mass is unknown, there is a need for an individual approach to defining the optimal therapeutic and diagnostic tactics, by attracting specialists in allied fields. 

  8. Calcifying epithelial odontogenic tumor.

    Science.gov (United States)

    Pereira, Olavo Hoston Gonçalves; de Carvalho, Laura Priscila Barboza; Lacerda Brasileiro Junior, Vilson; de Figueiredo, Cláudia Roberta Leite Vieira

    2013-01-01

    The calcifying epithelial odontogenic tumor (CEOT) is a rare benign epithelial odontogenic neoplasm of slow growth that is locally aggressive and tends to invade bone and adjacent soft tissue. Here is reported the case of a 21-year-old female patient with a CEOT in the left mandibular posterior region. The computerized tomography in coronal plane revealed a hypodense lesion in the posterior region of the left mandibular body with hyperdense areas inside and was associated with element 37. An incisional biopsy of the lesion was performed and the histopathological analysis revealed the presence of layers of epithelial odontogenic cells that formed prominent intercellular bridges. A large quantity of extracellular, eosinophilic, and amyloid-like material and an occasional formation of concentric calcifications (Liesegang rings) were also found. The histopathological diagnosis was a Pindborg tumor. Resection of the tumor with a safety margin was performed and after 6 months of follow-up there has been no sign of recurrence of the lesion.

  9. Pindborg tumor in children.

    Science.gov (United States)

    Ungari, Claudio; Poladas, Giulio; Giovannetti, Filippo; Carnevale, Cristina; Iannetti, Giorgio

    2006-03-01

    Pindborg tumor or calcifying epithelial odontogenic tumor is a rare benign neoplasm. The average age at diagnosis is 40 years without a significant prevalence for one sex. The most frequent localization is the mandibular premolar and molar area; less frequently the lesion is found in the maxilla, while other localizations like the maxillary sinus are extremely rare. Ethiology of this lesion is not clear. The complete surgical removal of the lesion is usually considered the most common type of treatment. The authors report a peculiar case of Pindborg tumor characterized by a rare localization of the lesion (maxillary incisal area) and by the young age of the patient (nine years old). The correct treatment in the case of a small mass is the surgical enucleation of the lesion. The purpose of the surgical treatment is the radical resection of the neoplasm with clean margins in order to reduce the risk of recurrence of disease. Recurrence of disease many years after surgical therapy has been reported that is why a clinical and instrumental long-term follow-up of the patient are suggested.

  10. Calcifying Epithelial Odontogenic Tumor

    Directory of Open Access Journals (Sweden)

    Olavo Hoston Gonçalves Pereira

    2013-01-01

    Full Text Available The calcifying epithelial odontogenic tumor (CEOT is a rare benign epithelial odontogenic neoplasm of slow growth that is locally aggressive and tends to invade bone and adjacent soft tissue. Here is reported the case of a 21-year-old female patient with a CEOT in the left mandibular posterior region. The computerized tomography in coronal plane revealed a hypodense lesion in the posterior region of the left mandibular body with hyperdense areas inside and was associated with element 37. An incisional biopsy of the lesion was performed and the histopathological analysis revealed the presence of layers of epithelial odontogenic cells that formed prominent intercellular bridges. A large quantity of extracellular, eosinophilic, and amyloid-like material and an occasional formation of concentric calcifications (Liesegang rings were also found. The histopathological diagnosis was a Pindborg tumor. Resection of the tumor with a safety margin was performed and after 6 months of follow-up there has been no sign of recurrence of the lesion.

  11. Neuroendocrine Tumor, diagnostic difficulties

    Directory of Open Access Journals (Sweden)

    Pedro Oliveira

    2017-06-01

    Full Text Available Ectopic adrenocorticotropic hormone (ACTH secretion is a rare disease. A 51 years old woman, with a Cushing syndrome secondary to ectopic ACTH secretion, diagnosed in 2009, with mediastinal lymphadenopathy, whose biopsy was compatible with lung small cell carcinoma, staged as IIIB using TNM classification. No other lesions were found in patient study. The patient was submitted to chemotherapy, associated to ketoconazole 200 mg twice daily, with partial remission of both conditions. Three years later was admitted with an aggravation of Cushing syndrome. There was no evidence of progression of pulmonary disease. A cystic lesion in the pancreatic uncinated process was found by abdominal CT scan and with avid uptake by DOTANOC PET discreet in anterior mediastinal lymphadenopathy. Biopsy of pancreatic mass revealed a neuroendocrine tumor. Pulmonary masses were biopsied again and was in favor of neuroendocrine tumor. It was assumed the diagnosis of pancreatic neuroendocrine tumor with mediastinal metastasis. The patient initiated lanreotid (120 mg, monthly, subcutaneous in association with ketoconazole. After 5 months of therapy, patient died with sepsis secondary to pneumonia. Neuroendocrine tumours are rare, difficult to diagnose and with poor prognosis when associated with ectopic ACTH secreting Cushing syndrome.

  12. Wilms′ tumor: An update

    Directory of Open Access Journals (Sweden)

    Hemant B Tongaonkar

    2007-01-01

    Full Text Available Wilms′ tumor (WT is the commonest pediatric renal tumor, predominantly seen in children less than five years of age. The majority of patients present with an abdominal lump and CT scan is the usual imaging modality for determining the extent of disease. With multimodality management, the results of treatment of WT have improved dramatically over the last 50 years. The treatment protocols have been devised and modified repeatedly depending on evidence from randomized trials by several cooperative groups - mainly National Wilms′ Tumor Study Group (NWTSG and the International Society of Pediatric Oncology (SIOP. The NWTSG recommends primary surgery followed by chemotherapy while SIOP advocates four weeks of chemotherapy prior to surgery. The regimen, dose and duration of chemotherapy have been repeatedly modified to reduce toxicity while maintaining efficacy. The role of radiation therapy has also been customized. Most centers have reported excellent survival rates with the modern day treatment protocols, except in patients with an unfavorable histology. The results of treatment of relapsed WT have also improved with newer drugs and combinations being used for the same.

  13. Cardiac tumors: echo assessment

    Directory of Open Access Journals (Sweden)

    Rekha Mankad MD

    2016-12-01

    Full Text Available Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series. They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1 thrombus or vegetations are the most likely etiology, (2 cardiac tumors are mostly secondary and (3 primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

  14. Pulmonary tumor microembolism

    Energy Technology Data Exchange (ETDEWEB)

    Bennink, R.; Roo, M. de; Mortelmans, L. [Catholic Univ. Leuven (Belgium). Dept. of Nuclear Medicine; Wijngaerden, E. van [Catholic Univ. Leuven (Belgium). Dept. of Internal Medicine

    1998-06-01

    Pulmonary tumor embolism is an often missed antemortem diagnosis in patients with cancer and respiratory failure. Although rare, this complication is an important cause of additional morbidity. Referred for radionuclide pulmonary perfusion and ventilation scintigraphy, a typical pattern of multiple subsegmental peripheral defects on perfusion lung scanning without matching ventilation defects, suggesting a high probability for pulmonary thromboembolism, often leads to false conclusions. We present a case of bilateral multiple subsegmental mismatched defects in lung ventilation perfusion scintigraphy, where autopsy confirmed the diagnosis of pulmonary tumor embolism, secondary to an undifferentiated ductal type adenocarcinoma of the pancreas. Pulmonary tumor embolism is an entity to keep in mind in patients treated for carcinoma presenting with (sub) acute dyspnea. (orig.) [Deutsch] Die tumorbedingte Lungenembolie ist eine haeufig uebersehene antemortale Diagnose bei Patienten mit Karzinom und respiratorischer Insuffizienz. Diese Komplikation ist selten, sie ist jedoch eine bedeutende Ursache einer zusaetzlichen Morbiditaet. Bei Patienten, die zur Radionuklid-Perfusions- und Ventilationslungenszintigraphie ueberwiesen werden, findet sich ein typisches Muster mit multiplen, subsegmentalen, peripheren Defekten auf dem Perfusionslungenszintigramm ohne entsprechende Ventilationsdefekte, das auf eine hohe Wahrscheinlichkeit einer pulmonalen Thromboseembolie hinweist und haeufig zu falschen Schluessen fuehrt. Wir stellen einen Fall mit bilateralen, multiplen, subsegmentalen, nicht uebereinstimmenden Defekten bei der Lungenventilations- und Perfusionsszintigraphie vor, bei dem die Autopsie die Diagnose einer tumorbedingten Lungenembolie bestaetigte, die auf ein undifferenziertes duktales Adenokarzinom des Pankreas zurueckfuehrbar war. Die tumorbedingte Lungenembolie ist eine Entitaet, an die bei Patienten, die wegen eines Karzinoms behandelt werden und sich mit (sub

  15. Cerebral tumor or pseudotumor?

    Science.gov (United States)

    Leclercq, D; Trunet, S; Bertrand, A; Galanaud, D; Lehéricy, S; Dormont, D; Drier, A

    2014-10-01

    Pseudotumoral lesions are uncommon but important to identity lesions. They can occur during inflammatory diseases (systemic diseases, vasculitis, demyelinating diseases), infectious, and vascular diseases. Also, in a patient with a treated tumor, pseudo-progression and radionecrosis must be differentiated from the tumoral development. Diagnosis can be difficult on an MRI scan, but some MRI aspects in conventional sequences, diffusion, perfusion and spectroscopy can suggest the pseudotumoral origin of a lesion. Imaging must be interpreted according to the context, the clinic and the biology. The presence of associated intracranial lesions can orientate towards a systemic or infectious disease. A T2 hyposignal lesion suggests granulomatosis or histiocytosis, especially if a meningeal or hypothalamic-pituitary involvement is associated. Non-tumoral lesions are generally not hyperperfused. In the absence of a definitive diagnosis, the evolution of these lesions, whether under treatment or spontaneous, is fundamental. Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  16. Cellular Potts modeling of tumor growth, tumor invasion and tumor evolution

    NARCIS (Netherlands)

    A. Szabó (Andras); R.M.H. Merks (Roeland)

    2013-01-01

    htmlabstractDespite a growing wealth of available molecular data, the growth of tumors, invasion of tumors into healthy tissue, and response of tumors to therapies are still poorly understood. Although genetic mutations are in general the first step in the development of a cancer, for the mutated

  17. Odontogenic Tumor Markers - An Overview

    Science.gov (United States)

    Premalatha, B R; Patil, Shankargouda; Rao, Roopa S; Reddy, Narendranatha P; Indu, M

    2013-01-01

    The practice of pathology is currently undergoing significant change, due to advances in the field of molecular pathology. Tumor markers are molecules that help the pathologists for confirmatory diagnosis of histopathologically confounding lesions. Odontogenic tumors are relatively rare with estimated incidence of less than 0.5 cases/ 100,000 population per year. Odontogenic tumors can pose diagnostic challenges because of overlapping histology. But, appropriate diagnosis is crucial as their treatment modality and prognosis differ; in these situations tumor markers can be helpful. But lack of comprehensive literature on specific markers for odontogenic tumors imposes pathologists to think aimlessly about various markers to arrive at an appropriate diagnosis. With this background, it is our attempt at compiling diagnostically important odontogenic tumor markers. Also, a note is added on tumor behaviour studies in common clinically important odontogenic tumors: Ameloblastoma and Keratocystic odontogenic tumor. How to cite this article: Premalatha B R, Patil S, Rao R S, Reddy N P, Indu M. Odontogenic Tumor Markers - An Overview. J Int Oral Health 2013; 5(2):65-75. How to cite this article: Premalatha B R, Patil S, Rao R S, Reddy N P, Indu M. Odontogenic Tumor Markers - An Overview. J Int Oral Health 2013; 5(2):65-75 PMID:24155593

  18. Tumors of the optic nerve

    DEFF Research Database (Denmark)

    Lindegaard, Jens; Heegaard, Steffen

    2009-01-01

    A variety of lesions may involve the optic nerve. Mainly, these lesions are inflammatory or vascular lesions that rarely necessitate surgery but may induce significant visual morbidity. Orbital tumors may induce proptosis, visual loss, relative afferent pupillary defect, disc edema and optic...... atrophy, but less than one-tenth of these tumors are confined to the optic nerve or its sheaths. No signs or symptoms are pathognomonic for tumors of the optic nerve. The tumors of the optic nerve may originate from the optic nerve itself (primary tumors) as a proliferation of cells normally present...... in the nerve (e.g., astrocytes and meningothelial cells). The optic nerve may also be invaded from tumors originating elsewhere (secondary tumors), invading the nerve from adjacent structures (e.g., choroidal melanoma and retinoblastoma) or from distant sites (e.g., lymphocytic infiltration and distant...

  19. [Differential diagnostics of sebaceous tumors].

    Science.gov (United States)

    Böer-Auer, A

    2014-09-01

    Sebaceous tumors are epithelial tumors with a differentiation towards sebaceous adnexal structures of the skin. They imitate the epithelial cells of mature sebaceous glands, sebaceous ducts, immature (embryonic) sebaceous structures or sebaceous glands that are not stimulated by hormones (mantle structures). This article explains the classification of sebaceous tumors on the basis of the normal histology of sebaceous glands. Clinical and histopathological criteria are given for the most important sebaceous tumors. The differential diagnosis of sebaceoma, sebaceous adenoma and various types of sebaceous carcinoma is emphasized. The importance of a specific diagnosis of adnexal tumors is demonstrated by tumor-associated syndromes with involvement of other organs (e.g., Muir-Torre syndrome and Birt-Hogg-Dubé syndrome). Furthermore, conceptional controversies, problems in differential diagnosis and the impact of immunohistochemical staining in the assessment of sebaceous tumors are considered.

  20. Crucial involvement of tumor-associated neutrophils in the regulation of chronic colitis-associated carcinogenesis in mice.

    Directory of Open Access Journals (Sweden)

    Kun Shang

    Full Text Available Ulcerative colitis (UC is a major form of chronic inflammation that can frequently progress to colon cancer. Several studies have demonstrated massive infiltration of neutrophils and macrophages into the lamina propria and submucosa in the progression of UC-associated colon carcinogenesis. Macrophages contribute to the development of colitis-associated colon cancer (CAC. However, the role of neutrophils is not well understood. To better understand the involvement of tumor-associated neutrophils (TANs in the regulation of CAC, we used a mouse CAC model produced by administering azoxymethane (AOM, followed by repeated dextran sulfate sodium (DSS ingestion. This causes severe colonic inflammation and subsequent development of multiple tumors in mice colon. We observed that colorectal mucosal inflammation became increasingly severe with AOM and DSS treatment. Macrophages infiltrated the lamina propria and submucosa, together with a marked increase in neutrophil infiltration. The chemokine CXCL2 increased in the lamina propria and submucosal regions of the colons of the treated mice, together with the infiltration of neutrophils expressing CXCR2, a specific receptor for CXCL2. This process was followed by neoplastic transformation. After AOM and DSS treatment, the mice showed enhanced production of metalloproteinase (MMP-9 and neutrophil elastase (NE, accompanied by excessive vessel generation and cell proliferation. Moreover, CXCL2 promoted neutrophil recruitment and induced neutrophils to express MMP-9 and NE in vitro. Furthermore, administration of neutrophil-neutralizing antibodies after the last DSS cycle markedly reduced the number and size of tumors and decreased the expression of CXCR2, CXCL2, MMP-9, and NE. These observations indicate a crucial role for TANs in the initiation and progression of CAC and suggest that the CXCL2-CXCR2 axis might be useful in reducing the risk of UC-associated colon cancer.

  1. Collecting Tumor Samples From Patients With Gynecological Tumors

    Science.gov (United States)

    2016-10-26

    Borderline Ovarian Clear Cell Tumor; Borderline Ovarian Serous Tumor; Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Childhood Embryonal Rhabdomyosarcoma; Childhood Malignant Ovarian Germ Cell Tumor; Endometrioid Stromal Sarcoma; Gestational Trophoblastic Tumor; Malignant Mesothelioma; Malignant Ovarian Epithelial Tumor; Melanoma; Neoplasm of Uncertain Malignant Potential; Ovarian Brenner Tumor; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Serous Cystadenocarcinoma; Paget Disease of the Vulva; Recurrent Cervical Carcinoma; Recurrent Fallopian Tube Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Ovarian Germ Cell Tumor; Recurrent Primary Peritoneal Carcinoma; Recurrent Uterine Corpus Carcinoma; Recurrent Vaginal Carcinoma; Recurrent Vulvar Carcinoma; Stage I Ovarian Cancer; Stage I Uterine Corpus Cancer; Stage I Vaginal Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IA Fallopian Tube Cancer; Stage IA Ovarian Cancer; Stage IA Ovarian Germ Cell Tumor; Stage IB Cervical Cancer; Stage IB Fallopian Tube Cancer; Stage IB Ovarian Cancer; Stage IB Ovarian Germ Cell Tumor; Stage IC Fallopian Tube Cancer; Stage IC Ovarian Cancer; Stage IC Ovarian Germ Cell Tumor; Stage II Ovarian Cancer; Stage II Uterine Corpus Cancer; Stage II Vaginal Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIA Ovarian Germ Cell Tumor; Stage IIB Cervical Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIB Ovarian Germ Cell Tumor; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIC Ovarian Germ Cell Tumor; Stage III Borderline Ovarian Surface Epithelial-Stromal Tumor; Stage III Cervical Cancer; Stage III Uterine Corpus Cancer; Stage III Vaginal Cancer; Stage III Vulvar Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Ovarian Germ Cell

  2. CARCINOID TUMOR OF THE DUODENUM: a rare tumor at an unusual site. Case series from a single institution

    Directory of Open Access Journals (Sweden)

    Jaques WAISBERG

    2013-03-01

    Full Text Available Context Duodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated. Objective To analyze the clinicopathological characteristics of patients with resected duodenal carcinoids. Methods Twenty patients (12 females and 8 males were investigated. Their average age was 66.4 ± 5.8 years old (43 to 88 years old. The data corresponding to the clinical picture, diagnosis, treatment, and prognosis of patients with duodenal carcinoid tumors subjected to resection over a period of 18 years (1993-2011 were analyzed. Results The most common symptoms were dyspepsia (50% and epigastric pain (45% followed by weight loss (10% and vomiting (5%. Carcinoid syndrome was not observed in any patient. The lesion was located on the first part of the duodenum in 15 (75% patients, the second part in 4 (20% patients, and the third part in 1 (5% patient. The diagnosis of a carcinoid tumor was established through an endoscopic excision biopsy in 19 (95% patients and an histopathological examination of the surgical specimen in 1 (5% patient. The average tumor size was 1.1 cm ± 0.4 cm (0.3 cm to 6.0 cm. Nineteen (95% patients were initially treated by endoscopic resection of the duodenal lesion. One patient (5%, whose tumor was on the third part of the duodenum underwent a duodenectomy of the third and fourth duodenal parts and duodenojejunal anastomosis. The duodenal carcinoid resection margin was involved in four (20% patients. Four (20% patients were subjected to a partial gastrectomy to fully remove the lesion. The tumor was restricted to the submucosal layer in 16 (80% cases, and it penetrated into the muscular layer in 4 (20% cases. All patients exhibited positive chromogranin A, neuron-specific enolase, and/or synaptophysin immunostaining. The average duration of the follow-up period was 39.6 months (3 to 96 months. Twelve (60% of the 20 cases in this series are alive without any evidence of active

  3. Tumor fibroso solitario intraoral: análisis clinicopatológico e inmunohistoquímico Intraoral solitary fibrous tumor: clinical, pathologic, and immunohistochemical analysis

    Directory of Open Access Journals (Sweden)

    J.A. García de Marcos

    2008-06-01

    Full Text Available El tumor fibroso solitario (TFS es una neoplasia de partes blandas compuesta por células fusiformes, que principalmente se origina en las superficies mesoteliales. Generalmente tiene una localización intratorácica y la afectación de la cavidad oral es excepcional. Clínicamente el TFS intraoral suele presentarse como una masa móvil, submucosa, no dolorosa, bien circunscrita, de lento crecimiento. El diagnóstico se obtiene mediante al análisis histopatológico e inmunohistoquímico. Histológicamente se caracteriza por una disposición variable de células fusiformes ovoides, generalmente positivas para el marcador CD34. El tratamiento de elección es la extirpación quirúrgica de la lesión, recomendándose un seguimiento postoperatorio a largo plazo por la posibilidad de aparición de recurrencias y metástasis tardías. Presentamos un caso de TFS intraoral, localizado en el fondo del vestíbulo mandibular. Un año después de la resección quirúrgica de la lesión, no hay signos de recidiva local o regional. Asimismo, realizamos una revisión de la literatura.Solitary fibrous tumors (SFT are spindle cell neoplasms that most often originate from mesothelial lined surfaces. Intrathoracic tumors are more common and oral mucosal involvement is uncommon. Clinically, intraoral SFT is usually a painless, well delimited, slow-growing, mobile submucosal mass. Diagnosis is based on immunohistochemical and histopathologic analysis. Histologically, SFT is characterized by a variable provision of spindle cells, which generally are CD34-positive. Resection is the treatment of choice and long-term follow-up is recommended because recurrences and late metastases. We present a case of intraoral SFT of the mandibular vestibular sulcus. One year after surgical resection, there were no signs of local or regional recurrence. The literature was reviewed.

  4. SMT-Based Formal Verification of a TTEthernet Synchronization Function

    Science.gov (United States)

    Steiner, Wilfried; Dutertre, Bruno

    TTEthernet is a communication infrastructure for mixed-criticality systems that integrates dataflow from applications with different criticality levels on a single network. For applications of highest criticality, TTEthernet provides a synchronization strategy that tolerates multiple failures. The resulting fault-tolerant timebase can then be used for time-triggered communication to ensure temporal partitioning on the shared network.

  5. The ILLC-UvA SMT System for IWSLT 2010

    NARCIS (Netherlands)

    Khalilov, M.; Sima'an, K.; Federico, M.; Lane, I.; Paul, M.; Yvon, F.; Mariani, J.

    2010-01-01

    In this paper we give an overview of the ILLC-UvA (Institute for Logic, Language and Computation - University of Amsterdam) submission to the 7th International Workshop on Spoken Language Translation evaluation campaign. It outlines the architecture and configuration of the novel feature we are

  6. Lowering of tumor interstitial fluid pressure reduces tumor cell proliferation in a xenograft tumor model.

    Science.gov (United States)

    Hofmann, Matthias; Guschel, Maike; Bernd, August; Bereiter-Hahn, Jürgen; Kaufmann, Roland; Tandi, Christa; Wiig, Helge; Kippenberger, Stefan

    2006-02-01

    High tumor interstitial fluid pressure (TIFP) is a characteristic of most solid tumors. TIFP may hamper adequate uptake of macromolecular therapeutics in tumor tissue. In addition, TIFP generates mechanical forces affecting the tumor cortex, which might influence the growth parameters of tumor cells. This seems likely as, in other tissues (namely, blood vessels or the skin), mechanical stretch is known to trigger proliferation. Therefore, we hypothesize that TIFP-induced stretch modulates proliferation-associated parameters. Solid epithelial tumors (A431 and A549) were grown in Naval Medical Research Institute nude mice, generating a TIFP of about 10 mm Hg (A431) or 5 mm Hg (A549). Tumor drainage of the central cystic area led to a rapid decline of TIFP, together with visible relaxation of the tumor cortex. It was found by sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blot analysis that TIFP lowering yields a decreased phosphorylation of proliferation-associated p44/42 mitogen-activated protein kinase and tumor relaxation. In confirmation, immunohistochemical staining showed a decrease of tumor-associated proliferation marker Ki-67 after TIFP lowering. These data suggest that the mechanical stretch induced by TIFP is a positive modulator of tumor proliferation.

  7. Lowering of Tumor Interstitial Fluid Pressure Reduces Tumor Cell Proliferation in a Xenograft Tumor Model

    Directory of Open Access Journals (Sweden)

    Matthias Hofmann

    2006-02-01

    Full Text Available High tumor interstitial fluid pressure (TIFP is a characteristic of most solid tumors. TIFP may hamper adequate uptake of macromolecular therapeutics in tumor tissue. In addition, TIFP generates mechanical forces affecting the tumor cortex, which might influence the growth parameters of tumor cells. This seems likely as, in other tissues (namely, blood vessels or the skin, mechanical stretch is known to trigger proliferation. Therefore, we hypothesize that TIFP-induced stretch modulates proliferation-associated parameters. Solid epithelial tumors (A431 and A549 were grown in Naval Medical Research Institute nude mice, generating a TIFP of about 10 mm Hg (A431 or 5 mm Hg (A549. Tumor drainage of the central cystic area led to a rapid decline of TIFP, together with visible relaxation of the tumor cortex. It was found by sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blot analysis that TIFP lowering yields a decreased phosphorylation of proliferation-associated p44/42 mitogen-activated protein kinase and tumor relaxation. In confirmation, immunohistochemical staining showed a decrease of tumor-associated proliferation marker Ki-67 after TIFP lowering. These data suggest that the mechanical stretch induced by TIFP is a positive modulator of tumor proliferation.

  8. Lowering of Tumor Interstitial Fluid Pressure Reduces Tumor Cell Proliferation in a Xenograft Tumor Model1

    Science.gov (United States)

    Hofmann, Matthias; Guschel, Maike; Bernd, August; Bereiter-Hahn, Jürgen; Kaufmann, Roland; Tandi, Christa; Wiig, Helge; Kippenberger, Stefan

    2006-01-01

    Abstract High tumor interstitial fluid pressure (TIFP) is a characteristic of most solid tumors. TIFP may hamper adequate uptake of macromolecular therapeutics in tumor tissue. In addition, TIFP generates mechanical forces affecting the tumor cortex, which might influence the growth parameters of tumor cells. This seems likely as, in other tissues (namely, blood vessels or the skin), mechanical stretch is known to trigger proliferation. Therefore, we hypothesize that TIFP-induced stretch modulates proliferation-associated parameters. Solid epithelial tumors (A431 and A549) were grown in Naval Medical Research Institute nude mice, generating a TIFP of about 10 mm Hg (A431) or 5 mm Hg (A549). Tumor drainage of the central cystic area led to a rapid decline of TIFP, together with visible relaxation of the tumor cortex. It was found by sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blot analysis that TIFP lowering yields a decreased phosphorylation of proliferation-associated p44/42 mitogen-activated protein kinase and tumor relaxation. In confirmation, immunohistochemical staining showed a decrease of tumor-associated proliferation marker Ki-67 after TIFP lowering. These data suggest that the mechanical stretch induced by TIFP is a positive modulator of tumor proliferation. PMID:16611401

  9. Reovirus and tumor oncolysis.

    Science.gov (United States)

    Kim, Manbok; Chung, Young-Hwa; Johnston, Randal N

    2007-06-01

    REOviruses (Respiratory Enteric Orphan viruses) are ubiquitous, non-enveloped viruses containing 10 segments of double-stranded RNA (dsRNA) as their genome. They are common isolates of the respiratory and gastrointestinal tract of humans but are not associated with severe disease and are therefore considered relatively benign. An intriguing characteristic of reovirus is its innate oncolytic potential, which is linked to the transformed state of the cell. When immortalized cells are transfected in vitro with activated oncogenes such as Ras, Sos, v-erbB, or c-myc, they became susceptible to reovirus infection and subsequent cellular lysis, indicating that oncogene signaling pathways are exploited by reovirus. This observation has led to the use of the virus in clinical trials as an anti-cancer agent against oncogenic tumors. In addition to the exploitation of oncogene signaling, reovirus may further utilize host immune responses to enhance its antitumor activity in vivo due to its innate interferon induction ability. Reovirus is, however, not entirely benign to immunocompromised animal models. Reovirus causes so-called "black feet syndrome" in immunodeficient mice and can also harm neonatal animals. Because cancer patients often undergo immunosuppression due to heavy chemo/radiation-treatments or advanced tumor progression, this pathogenic response may be a hurdle in virus-based anticancer therapies. However, a genetically attenuated reovirus variant derived from persistent reovirus infection of cells in vitro is able to exert potent anti-tumor activity with significantly reduced viral pathogenesis in immunocompromised animals. Importantly, in this instance the attenuated reovirus maintains its oncolytic potential while significantly reducing viral pathogenesis in vivo.

  10. Tumor-colonizing bacteria: a potential tumor targeting therapy.

    Science.gov (United States)

    Zu, Chao; Wang, Jiansheng

    2014-08-01

    In 1813, Vautier published his observation of tumor regression in patients who had suffered from gas gangrene. Since then, many publications have described the use of bacteria as antitumor therapy. For example, Bifidobacterium and Clostridium have been shown to selectively colonize tumors and to reduce tumor size. In addition, recent studies have focused on the use of genetic engineering to induce the expression of pro-drug converting enzymes, cytokines, specific antibodies, or suicide genes in tumor-colonizing bacteria. Moreover, some animal experiments have reported the treatment of tumors with engineered bacteria, and few side effects were observed. Therefore, based on these advances in tumor targeting therapy, bacteria may represent the next generation of cancer therapy.

  11. Pituitary tumors containing cholecystokinin

    DEFF Research Database (Denmark)

    Rehfeld, J F; Lindholm, J; Andersen, B N

    1987-01-01

    We found small amounts of cholecystokinin in the normal human adenohypophysis and therefore examined pituitary tumors from 87 patients with acromegaly, Cushing's disease, Nelson's syndrome, prolactinoma, or inactive pituitary adenomas. Five adenomas associated with Nelson's syndrome contained...... increased amounts of cholecystokinin, the concentrations being extremely high in two: 8281 and 13,453 pmol per gram as compared with less than 30 pmol per gram in normal pituitary glands. The cholecystokinin concentrations were moderately increased in adenomas from another 12 patients, of whom 5 had Cushing...

  12. Adult wilms′ tumor

    Directory of Open Access Journals (Sweden)

    Sharma Mriganka

    2009-01-01

    Full Text Available Adult Wilms′ Tumor (AWT is a rare entity arising from the metanephric blastema. There are only about 200 cases reported in world literature. The staging of AWT is done in the same way as in children according to the National Wilms′ Tumour Stage Group (NWTSG. Defini-tive treatment plans for AWT are undefined but surgical treatment has the highest priority. There is also consensus on the need for multimodality approach. We report a case of AWT who remains disease free, three years after undergoing multimodality treatment.

  13. Gastrointestinalni stromalni tumor (GIST)

    OpenAIRE

    Včev, Aleksandar; Begić, Ivana

    2002-01-01

    Stromalni / mezenhimalni tumori su dugo unosili konfuziju u klasifikaciji kao i prognostici biološkog ponašanja. Gastrointestinalni stromalni tumor uglavnom se javlja u srednjoj i starijoj životnoj dobi, s primarnom lokalizacijom 70% u želucu te 20% u tankom crijevu. Obično ostanu klinički pritajeni sve dok ne dosegnu veći promjer te izazovu simptome rupturiranjem, krvarenjem ili opstrukcijom. Terapija GIST-a je prototip liječenja zasnovanog na načelu "single target molecule" gdje je ciljni e...

  14. Malignant small round cell tumors

    Science.gov (United States)

    Rajwanshi, Arvind; Srinivas, Radhika; Upasana, Gautam

    2009-01-01

    Malignant small round cell tumors are characterised by small, round, relatively undifferentiated cells. They generally include Ewing's sarcoma, peripheral neuroectodermal tumor, rhabdomyosarcoma, synovial sarcoma, non-Hodgkin's lymphoma, retinoblastoma, neuroblastoma, hepatoblastoma, and nephroblastoma or Wilms’ tumor. Other differential diagnoses of small round cell tumors include small cell osteogenic sarcoma, undifferentiated hepatoblastoma, granulocytic sarcoma, and intraabdominal desmoplastic small round cell tumor. Differential diagnosis of small round cell tumors is particularly difficult due to their undifferentiated or primitive character. Tumors that show good differentiation are generally easy to diagnose, but when a tumor is poorly differentiated, identification of the diagnostic, morphological features is difficult and therefore, no definitive diagnosis may be possible. As seen in several study reports, fine needle aspiration cytology (FNAC) has become an important modality of diagnosis for these tumors. The technique yields adequate numbers of dissociated, viable cells, making it ideally suitable for ancillary techniques. Typically, a multimodal approach is employed and the principal ancillary techniques that have been found to be useful in classification are immunohistochemistry and immunophenotyping by flow cytometry, reverse transcriptase polymerase chain reaction (RT-PCR), fluorescence in situ hybridization (FISH), and electron microscopy. However, the recent characterization of chromosomal breakpoints and the corresponding genes involved in malignant small round cell tumors means that it is possible to use molecular genetic approaches for detection. PMID:21938141

  15. Imaging tumors of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Casadei, R., E-mail: roberto.casadei@ior.it [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Kreshak, J., E-mail: j.kreshak@yahoo.com [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Rinaldi, R. [Department of Radiology, Istituto Ortopedico Rizzoli, Bologna (Italy); Rimondi, E., E-mail: eugenio.rimondi@ior.it [Department of Radiology, Istituto Ortopedico Rizzoli, Bologna (Italy); Bianchi, G., E-mail: giuseppe.bianchi@ior.it [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Alberghini, M., E-mail: marco.alberghini@ior.it [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Ruggieri, P. [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Vanel, D., E-mail: daniel.vanel@ior.it [Department of Radiology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy)

    2013-12-01

    Background: Patellar tumors are rare; only a few series have been described in the literature and radiographic diagnosis can be challenging. We reviewed all patellar tumors at one institution and reviewed the literature. Materials and methods: In an evaluation of the database at one institution from 1916 to 2009, 23,000 bone tumors were found. Of these, 41 involved the patella. All had imaging studies and microscopic diagnostic confirmation. All medical records, imaging studies, and pathology were reviewed. Results: There were 15 females and 26 males, ranging from 8 to 68 years old (average 30). There were 30 benign tumors; eight giant cell tumors, eight chondroblastomas, seven osteoid osteomas, two aneurysmal bone cysts, two ganglions, one each of chondroma, exostosis, and hemangioma. There were 11 malignant tumors: five hemangioendotheliomas, three metastases, one lymphoma, one plasmacytoma, and one angiosarcoma. Conclusion: Patellar tumors are rare and usually benign. As the patella is an apophysis, the most frequent lesions are giant cell tumor in the adult and chondroblastoma in children. Osteoid osteomas were frequent in our series and easily diagnosed. Metastases are the most frequent malignant diagnoses in the literature; in our series malignant vascular tumors were more common. These lesions are often easily analyzed on radiographs. CT and MR define better the cortex, soft tissue extension, and fluid levels. This study presents the imaging patterns of the more common patellar tumors in order to help the radiologist when confronted with a lesion in this location.

  16. What is a pediatric tumor?

    Directory of Open Access Journals (Sweden)

    Mora J

    2012-11-01

    Full Text Available Jaume Mora1,21Department of Oncology, 2Developmental Tumor Biology Laboratory, Hospital Sant Joan de Deu, Fundacio Sant Joan de Deu, Barcelona, SpainAbstract: Working together with medical oncologists, the question of whether a Ewing sarcoma in a 25-year-old is a pediatric tumor comes up repeatedly. Like Ewing's, some tumors present characteristically at ages that cross over what has been set as the definition of pediatrics (15 years, 18 years, or 21 years?. Pediatric oncology textbooks, surprisingly, do not address the subject of defining a pediatric tumor. They all begin with an epidemiology chapter defining the types of tumors appearing at distinct stages of childhood, adolescence, and young adulthood. Describing the epidemiology of tumors in relation to age, it becomes clear that the disease is related to the phenomenon of aging. The question, however, remains: is there a biological definition of what pediatric age is? And if so, will tumors occurring during this period of life have anything to do with such biological definition? With the aim of finding an objective definition, the fundamental concepts of what defines "pediatrics" was reviewed and then the major features of tumors arising during development were analyzed. The tumors were explored from the perspective of a host immersed in the normal process of growth and development. This physiological process, from pluripotential and undifferentiated cells, makes possible the differentiation, maturation, organization, and function of tissues, organs, and apparatus. A biological definition of pediatric tumors and the infancy–childhood–puberty classification of developmental tumors according to the infancy–childhood–puberty model of normal human development are proposed.Keywords: growth and development, pediatric tumor, infant, childhood and adolescence, pubertal tumors

  17. Endoscopic ultrasound-assisted endoscopic resection of carcinoid tumors of the gastrointestinal tract Resección endoscópica asistida por ecoendoscopia de tumores carcinoides del aparato digestivo

    Directory of Open Access Journals (Sweden)

    D. Martínez-Ares

    2004-12-01

    Full Text Available Introduction: usually found in the gastrointestinal tract, carcinoids are the most frequent neuroendocrine tumors. Most of these lesions are located in areas that are difficult to access using conventional endoscopy (small intestine and appendix; carcinoid tumors found in the gastroduodenal tract and in the large intestine can be studied endoscopically; in these cases, if localized disease is confirmed, local treatment by endoscopic resection may be the treatment of choice. Since endoscopic ultrasonography has been shown to be the technique of choice for the study of tumors exhibiting submucosal growth, the selection of patients who are candidates for a safe and effective local resection should be based on this technique. Patients and method: we selected patients with gastrointestinal carcinoid tumors who were endoscopically treated between 1997 and 2002. Those patients with tumors measuring less than 10 mm, which had not penetrated the muscularis propria, and those with localized disease were considered candidates for endoscopic resection. The endpoints of this study were to assess the effectiveness (complete resection and safety (complications of the technique. Follow-up consisted of eschar biopsies performed one month and twelve months after the resection. Results: during the aforementioned period, we resected endoscopically 24 tumors in 21 patients (mean age: 51.7 years; 71.5% males. Most lesions were incidental discoveries made during examinations indicated for other reasons. Resection was indicated in most cases as a result of the suspected presence of a carcinoid tumor after endoscopic ultrasonography. Endoscopic ultrasonography also enabled us to clearly identify the layer where the lesion had originated, as well as the size of the lesion. The carcinoid tumor was removed in 13 cases (54.2% by using the conventional snare polypectomy technique, in 9 cases (37.5% assisted by a submucosal injection of saline solution and/or adrenaline, and

  18. Calcifying epithelial odontogenic tumor (Pindborg tumor): an unusual case.

    Science.gov (United States)

    Baunsgaard, P; Løntoft, E; Sørensen, M

    1983-05-01

    A case of the rare calcifying epithelial odontogenic tumor is reported. The tumor was situated high in the left maxillary antrum, bulging into the nasal cavity. The presenting signs were homolateral nasal stenosis and bulging of the lateral nasal wall. The clinical appearances and histological findings are submitted and compared with those in cases described previously. Treatment and prognosis are discussed. From the present case it is apparent that despite its odontogenic nature the tumor may occur so far from the teeth that clinically it may be mistaken for a tumor of the nasal cavity.

  19. Multiparametric classification links tumor microenvironments with tumor cell phenotype.

    Directory of Open Access Journals (Sweden)

    Bojana Gligorijevic

    2014-11-01

    Full Text Available While it has been established that a number of microenvironment components can affect the likelihood of metastasis, the link between microenvironment and tumor cell phenotypes is poorly understood. Here we have examined microenvironment control over two different tumor cell motility phenotypes required for metastasis. By high-resolution multiphoton microscopy of mammary carcinoma in mice, we detected two phenotypes of motile tumor cells, different in locomotion speed. Only slower tumor cells exhibited protrusions with molecular, morphological, and functional characteristics associated with invadopodia. Each region in the primary tumor exhibited either fast- or slow-locomotion. To understand how the tumor microenvironment controls invadopodium formation and tumor cell locomotion, we systematically analyzed components of the microenvironment previously associated with cell invasion and migration. No single microenvironmental property was able to predict the locations of tumor cell phenotypes in the tumor if used in isolation or combined linearly. To solve this, we utilized the support vector machine (SVM algorithm to classify phenotypes in a nonlinear fashion. This approach identified conditions that promoted either motility phenotype. We then demonstrated that varying one of the conditions may change tumor cell behavior only in a context-dependent manner. In addition, to establish the link between phenotypes and cell fates, we photoconverted and monitored the fate of tumor cells in different microenvironments, finding that only tumor cells in the invadopodium-rich microenvironments degraded extracellular matrix (ECM and disseminated. The number of invadopodia positively correlated with degradation, while the inhibiting metalloproteases eliminated degradation and lung metastasis, consistent with a direct link among invadopodia, ECM degradation, and metastasis. We have detected and characterized two phenotypes of motile tumor cells in vivo, which

  20. Ghrelin and tumors.

    Science.gov (United States)

    Papotti, Mauro; Duregon, Eleonora; Volante, Marco

    2013-01-01

    Since the original discovery of ghrelin and, subsequently, obestatin (the alternative product of the ghrelin gene), a major interest has been devoted to the investigation of their central and peripheral activities in physiological conditions as well as on their role in metabolic diseases. However, several studies with different methodological approaches variably identified ghrelin and obestatin synthesis and secretion in several neoplastic conditions, including neuroendocrine and non-neuroendocrine cancers of various sites. Moreover, in vitro studies showed the capability of ghrelin to modulate tumor cell functions such as cell proliferation, apoptosis and invasiveness, although with variable and even paradoxical effects in different cell models. Interestingly, in most studies, it was demonstrated that ghrelin exerts its pro- or antineoplastic properties by means of receptors other than GHSR1a, that still need to be identified. However, the possible usefulness of the modulation of the ghrelin/obestatin axis in neoplastic conditions using either synthetic agonists or antagonists, though interesting in perspective, is still far from clinical applicability, and probably more related to the regulation of specific metabolic pathways in tumor cells, including lipid and carbohydrate use, than to the specific modulation of cell proliferation. Copyright © 2013 S. Karger AG, Basel.

  1. Dynamic CT of pancreatic tumors

    Energy Technology Data Exchange (ETDEWEB)

    Hosoki, T.

    1983-05-01

    Dynamic computed tomography was performed on 19 patients with clinically diagnosed pancreatic and peripancreatic tumors. There were 10 patients with pancreatic cancer, three with inflammatory pancreatic masses, two with cystadenoma, one with insuloma, and three with peripancreatic tumors. Computed tomography was performed with a Varian-V-360-3 scanner; scanning was for 30 consecutive sec at 3 sec intervals after the bolus injection of 50 ml of contrast medium into the antecubital vein. Dynamic computed tomography (CT) may be more useful than conventional contrast CT because it facilitates: (1) correct evaluation of tumor vascularity allowing a differential diagnosis; (2) location of the boundary between tumor and a nontumor tissue; (3) detection of small tumors; and (4) visualization of pancreatic invasion by peripancreatic tumors. In addition, contrast enhancement and the degree of vascular proliferation can be quantitatively assessed by analyzing time-density curves.

  2. Pericytes limit tumor cell metastasis

    DEFF Research Database (Denmark)

    Xian, Xiaojie; Håkansson, Joakim; Ståhlberg, Anders

    2006-01-01

    Previously we observed that neural cell adhesion molecule (NCAM) deficiency in beta tumor cells facilitates metastasis into distant organs and local lymph nodes. Here, we show that NCAM-deficient beta cell tumors grew leaky blood vessels with perturbed pericyte-endothelial cell-cell interactions...... the microvessel wall. To directly address whether pericyte dysfunction increases the metastatic potential of solid tumors, we studied beta cell tumorigenesis in primary pericyte-deficient Pdgfb(ret/ret) mice. This resulted in beta tumor cell metastases in distant organs and local lymph nodes, demonstrating a role...... and deficient perivascular deposition of ECM components. Conversely, tumor cell expression of NCAM in a fibrosarcoma model (T241) improved pericyte recruitment and increased perivascular deposition of ECM molecules. Together, these findings suggest that NCAM may limit tumor cell metastasis by stabilizing...

  3. Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan.

    Science.gov (United States)

    Hatta, Waku; Gotoda, Takuji; Oyama, Tsuneo; Kawata, Noboru; Takahashi, Akiko; Yoshifuku, Yoshikazu; Hoteya, Shu; Nakamura, Koki; Hirano, Masaaki; Esaki, Mitsuru; Matsuda, Mitsuru; Ohnita, Ken; Shimoda, Ryo; Yoshida, Motoyuki; Dohi, Osamu; Takada, Jun; Tanaka, Keiko; Yamada, Shinya; Tsuji, Tsuyotoshi; Ito, Hirotaka; Hayashi, Yoshiaki; Nakamura, Tomohiro; Shimosegawa, Tooru

    2017-02-01

    Although radical surgery is routinely performed for patients who do not meet the curative criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM), this standard therapeutic option may be excessive given the lower number of patients with LNM. Therefore, we aimed to investigate long-term outcomes and validate risk factors predicting recurrence after ESD. Of 15,785 patients who underwent ESD for EGC at 19 institutions between 2000 and 2011, 1969 patients not meeting the curative criteria were included in this multi-center study. Based on the treatment strategy after ESD, patients were divided into radical surgery (n = 1064) and follow-up (no additional treatment, n = 905) groups. Overall survival (OS) and disease-specific survival (DSS) were significantly higher in the radical surgery group than in the follow-up group (p < 0.001 and p = 0.012, respectively). However, the difference in 3-year DSS between the groups (99.4 vs. 98.7 %) was rather small compared with the difference in 3-year OS (96.7 vs. 84.0 %). LNM was found in 89 patients (8.4 %) in the radical surgery group. Lymphatic invasion was found to be an independent risk factor for recurrence in the follow-up group (hazard ratio 5.23; 95 % confidence interval 2.01-13.6; p = 0.001). This multi-center study, representing the largest cohort to date, revealed a large discrepancy between OS and DSS in the two groups. Since follow-up with no additional treatment after ESD may be an acceptable option for patients at low risk, further risk stratification is needed for appropriate individualized treatment strategies.

  4. Proton Therapy for Thoracoabdominal Tumors

    Science.gov (United States)

    Sakurai, Hideyuki; Okumura, Toshiyuki; Sugahara, Shinji; Nakayama, Hidetsugu; Tokuuye, Koichi

    In advanced-stage disease of certain thoracoabdominal tumors, proton therapy (PT) with concurrent chemotherapy may be an option to reduce side effects. Several technological developments, including a respiratory gating system and implantation of fiducial markers for image guided radiation therapy (IGRT), are necessary for the treatment in thoracoabdominal tumors. In this chapter, the role of PT for tumors of the lung, the esophagus, and liver are discussed.

  5. Self-scaling tumor growth

    DEFF Research Database (Denmark)

    Schmiegel, Jürgen

    We study the statistical properties of the star-shaped approximation of in vitro tumor profiles. The emphasis is on the two-point correlation structure of the radii of the tumor as a function of time and angle. In particular, we show that spatial two-point correlators follow a cosine law....... Based on this similarity, we provide a Lévy based model that captures the correlation structure of the radii of the star-shaped tumor profiles....

  6. Tumors of the lacrimal gland

    DEFF Research Database (Denmark)

    von Holstein, Sarah Linea; Rasmussen, Peter Kristian; Heegaard, Steffen

    2016-01-01

    Tumors of the lacrimal gland comprise a wide spectrum, of which the most common demonstrate epithelial and lymphoid differentiation. The diagnosis of lacrimal gland tumors depends primarily on histological evaluation, as do the choice of treatment and prognosis. For some lacrimal gland neoplasms......, such as adenoid cystic carcinoma, the outlook is grave. Optimal treatment for several lacrimal gland tumors is also a matter of controversy. However, recent progress has been made in the molecular and genetic understanding of tumorigenesis for such lesions. This article presents an overview of the histopathology...... of lacrimal gland tumors, together with their epidemiological features, clinical characteristics, and treatment strategies....

  7. Surgical Treatment in Uveal Tumors

    Directory of Open Access Journals (Sweden)

    Kaan Gündüz

    2014-09-01

    Full Text Available Surgical treatment in uveal tumors can be done via iridectomy, partial lamellar sclerouvectomy (PLSU and endoresection. Iridectomy is done in iris tumors without angle and ciliary body involvement. PLSU is performed in tumors with ciliary body and choroidal involvement. For this operation, a partial thickness scleral flap is dissected, the intraocular tumor is excised, and the flap is sutured back in position. PLSU surgery is done in iridociliary and ciliary body tumors with less than 3 clock hours of iris and ciliary body involvement and in choroidal tumors with a base diameter less than 15 mm. However, it can be employed in any size tumor for biopsy purposes. Potential complications of PLSU surgery include vitreous hemorrhage, cataract, retinal detachment, and endophthalmitis. Endoresection is a technique whereby the intraocular tumor is excised using vitrectomy techniques. The rationale for performing endoresection is based on the fact that irradiated uveal melanomas may be associated with exudation and neovascular glaucoma and removing the dead tumor tissue may contribute to better visual outcome. There are some centers where endoresection is done without prior radiotherapy. Allegedly, avoidance of radiation retinopathy and papillopathy are the main advantages of using endoresection without prior radiotherapy. (Turk J Ophthalmol 2014; 44: Supplement 29-34

  8. Monitoring Radiographic Brain Tumor Progression

    Directory of Open Access Journals (Sweden)

    John H. Sampson

    2011-03-01

    Full Text Available Determining radiographic progression in primary malignant brain tumors has posed a significant challenge to the neuroncology community. Glioblastoma multiforme (GBM, WHO Grade IV through its inherent heterogeneous enhancement, growth patterns, and irregular nature has been difficult to assess for progression. Our ability to detect tumor progression radiographically remains inadequate. Despite the advanced imaging techniques, detecting tumor progression continues to be a clinical challenge. Here we review the different criteria used to detect tumor progression, and highlight the inherent challenges with detection of progression.

  9. Management of borderline ovarian tumors.

    Science.gov (United States)

    Tîrnovanu, Mihaela-Camelia; Amancei, Simona; Dumitrescu, A; Onofriescu, M; Dumitraşcu, Irina

    2012-01-01

    Borderline ovarian tumors are an intermediate stage between benign cystadenomas and adenocarcinomas. The paper evaluates the management of borderline ovarian tumors (BOTs) in the patients admitted and treated in our clinic in the interval January 2003 - June 2011. The observation sheets and pathology results of 264 patients with malignant ovarian tumors were analyzed. Of the 264 malignant ovarian tumors 74 (28.03%) were low malignant potential. Patients with BOT were aged 18-72 years (mean 46 +/- 6.2 years) and those with invasive tumors 14-83 years (mean 53 +/- 9.8 years). 92.18% were in stage 1. Sixty tumors were graded G1. 53.52 % of the tumors were over 10 cm (maximum 30 cm) in size. The histological types were: serous - 35 cases, mucinous - 19 cases, mixed (serous and mucinous) - 8 cases, and endometrioid - 2 cases. Fifteen patients presented intraepithelial carcinoma and 11 noninvasive implants into the peritoneal cavity. Five women had recurrences. Ovarian borderline tumors with histological characteristics of carcinoma, but with good behavior are now with better defined histological features. The biggest challenge in the management of women with these tumors is to identify the subset that will behave in a malignant fashion and to develop effective treatment for them.

  10. Desmoid tumor within lesser sac

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2006-01-01

    Full Text Available Desmoid tumors or fibromatoses comprise a number of benign fibrous proliferative lesions that have local infiltrative growth and tendency to recur after incomplete excision. They never metastasize. The authors present a 31-year old woman who, due to epigastric pain and palpable mass detected on presentation, underwent the excision of firm tumorous mass, 210x140x115mm in diameter, from the lesser sac. Compressing the splenic vein, the tumor caused left-sided portal hypertension which subsided after the mass was removed. The recovery was uneventful. The histological examination verified typical desmoid tumor. Twelve years after surgery, the patient remained symptom-free with no signs of recurrence.

  11. Glutathione Levels in Human Tumors

    Science.gov (United States)

    Gamcsik, Michael P.; Kasibhatla, Mohit S.; Teeter, Stephanie D.; Colvin, O. Michael

    2013-01-01

    This review summarizes clinical studies in which glutathione was measured in tumor tissue from patients with brain, breast, gastrointestinal, gynecological, head and neck and lung cancer. Glutathione tends to be elevated in breast, ovarian, head and neck and lung cancer and lower in brain and liver tumors compared to disease-free tissue. Cervical, colorectal, gastric and esophageal cancers show both higher and lower levels of tumor glutathione. Some studies show an inverse relationship between patient survival and tumor glutathione. Based on this survey, we recommend approaches that may improve the clinical value of glutathione as a biomarker. PMID:22900535

  12. Skull base tumor model.

    Science.gov (United States)

    Gragnaniello, Cristian; Nader, Remi; van Doormaal, Tristan; Kamel, Mahmoud; Voormolen, Eduard H J; Lasio, Giovanni; Aboud, Emad; Regli, Luca; Tulleken, Cornelius A F; Al-Mefty, Ossama

    2010-11-01

    Resident duty-hours restrictions have now been instituted in many countries worldwide. Shortened training times and increased public scrutiny of surgical competency have led to a move away from the traditional apprenticeship model of training. The development of educational models for brain anatomy is a fascinating innovation allowing neurosurgeons to train without the need to practice on real patients and it may be a solution to achieve competency within a shortened training period. The authors describe the use of Stratathane resin ST-504 polymer (SRSP), which is inserted at different intracranial locations to closely mimic meningiomas and other pathological entities of the skull base, in a cadaveric model, for use in neurosurgical training. Silicone-injected and pressurized cadaveric heads were used for studying the SRSP model. The SRSP presents unique intrinsic metamorphic characteristics: liquid at first, it expands and foams when injected into the desired area of the brain, forming a solid tumorlike structure. The authors injected SRSP via different passages that did not influence routes used for the surgical approach for resection of the simulated lesion. For example, SRSP injection routes included endonasal transsphenoidal or transoral approaches if lesions were to be removed through standard skull base approach, or, alternatively, SRSP was injected via a cranial approach if the removal was planned to be via the transsphenoidal or transoral route. The model was set in place in 3 countries (US, Italy, and The Netherlands), and a pool of 13 physicians from 4 different institutions (all surgeons and surgeons in training) participated in evaluating it and provided feedback. All 13 evaluating physicians had overall positive impressions of the model. The overall score on 9 components evaluated--including comparison between the tumor model and real tumor cases, perioperative requirements, general impression, and applicability--was 88% (100% being the best possible

  13. Bronchial carcinoid tumors: A rare malignant tumor | Orakwe ...

    African Journals Online (AJOL)

    Bronchial carcinoid tumors (BCTs) are an uncommon group of lung tumors. They commonly affect the young adults and the middle aged, the same age group affected by other more common chronic lung conditions such as pulmonary tuberculosis. Diagnosis is commonly missed or delayed due to a low index of suspicion.

  14. Tumor-related hyponatremia.

    Science.gov (United States)

    Onitilo, Adedayo A; Kio, Ebenezer; Doi, Suhail A R

    2007-12-01

    Hyponatremia is an important and common electrolyte disorder in tumor patients and one that has been reported in association with a number of different primary diagnoses. The correct diagnosis of the pathophysiological basis for each patient is important because it significantly alters the treatment approach. In this article, we review the epidemiology and presentation of patients with hyponatremia, the pathophysiologic groups for the disorder with respect to sodium and water balance and the diagnostic measures for determining the correct pathophysiologic groups. We then present the various treatment options based on the pathophysiologic groups including a mathematical approach to the use of hypertonic saline in management. In cancer patients, hyponatremia is a serious comorbidity that requires particular attention as its treatment varies by pathophysiologic groups, and its consequences can have a deleterious effect on the patient's health.

  15. [A rare endolaryngeal tumor].

    Science.gov (United States)

    Ngo, Carine; Albert, Sébastien; Barry, Beatrix; Copie-Bergman, Christiane; Couvelard, Anne; Hourseau, Muriel

    2017-10-01

    We report the case of a 65-year-old woman who presented with a dysphonia. ENT tomography and laryngoscopy showed an endolaryngeal tumoral lesion extended to the right supraglottis. Biopsy of the lesion revealed dense lymphoid infiltrate in the lamina propria, without necrosis or ulceration of the mucosa. The infiltrate showed many CD3+, CD5+, CD4+, CD8+ lymphocytes and plasmocytes. Larger lymphoid cells with cytologic atypia expressed CD56 and cytotoxicity markers such as TIA1 and granzyme B. In situ hybridization for EBV revealed numerous positive cells. The diagnosis of extranodal NK/T cell lymphoma was proposed. The primary laryngeal localization of this disease is exceptionally rare. Heavy admixture of inflammatory cells may mimic inflammatory process and delay the diagnosis. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Sternomastoid tumor of infancy.

    Science.gov (United States)

    Thomsen, J R; Koltai, P J

    1989-12-01

    Sternomastoid tumor of infancy (SMTI) is the most common cause of neck mass in the perinatal period. We present seven children with this disorder, six studied prospectively. Ages at presentation ranged from 1 week to 4 weeks. Five had a history of birth trauma. Torticollis with facial asymmetry was seen in two. In six the diagnosis of SMTI was made clinically, and these patients were managed conservatively with massage and controlled stretching of the neck. Resolution of the neck mass, the torticollis, and the facial asymmetry occurred in all patients. Pathologic and radiographic findings are presented. We conclude that careful clinical assessment precludes the necessity of biopsy and emphasize the importance of conservative management of this transient problem.

  17. Solitary fibrous tumor

    Directory of Open Access Journals (Sweden)

    Andrea Bruzzone

    2010-12-01

    Full Text Available Solitary fibrous tumor (SFT is a rare mesenchymal neoplasm which may be found everywhere in the body. It is now distinguished into two forms, pleural and extrapleural, which morphologically resemble each other. Abdomi­nal localizations are quite rare, with 10 cases only reported in bladder; rarely they can be source of paraneoplastic syndromes (i.e., hypoglycemia secondary to insulin-like growth factor. In April 2006 a 74-year-old white male presented with chills, diaphoresis and acute abdominal pain with hematuria. At admission in emergency he underwent an abdominal X-ray (no pathological findings and an ultrasound examination of the kidneys and urinary tract, which revealed a pelvic hyperechogenic neoformation measuring approximately 10¥8¥7 cm, compressing the bladder. Blood chemistry at admission revealed only a mild neutrophilic leucocytosis (WBC 16600, N 80%, L 11%, elevated fibrinogen and ESR, and hypoglycemia (38 mg/dL. Macro­scopic hematuria was evident, while urinocolture was negative. Contrast enhanced CT scan of the abdomen and pelvic region revealed a large round neoformation dislocating the bladder, with an evident contrast-enhanced periphery and a central necrotic area. Continuous infusion of glucose 5% solution was necessary in order to maintain blood glucose levels above 50 mg/dL. The patient underwent complete surgical resection of an ovoidal mass coated by adipose tissue, with well delimited margins; histological findings were consistent with solitary fibrous tumor (SFT. Hypoglycemia resolved completely with removal of the growth. In this case report we describe a SFT growing in the bladder, a quite rare localization, which presented a unique hypoglycemia. In contrast to the majority of cases reported in the literature, the behavior of this SFT was not aggressive, and, since the patient is still alive, surgical resection was considered conclusive.

  18. Phyllodes Tumors of the Breast

    Science.gov (United States)

    Abusalem, Osama Turki; Al-Masri, Anwar

    2011-01-01

    Objective: To study all patients with phyllodes tumors of the breast which were diagnosed at King Hussien Medical Center and Prince Rashid Military Hospital between the 1st of may 2002 till January 2009. Methods: A total of 26 patients diagnosed to have phylloedes tumors were retrieved from the hospital records. All cases were analyzed and assessed in two main categories: demographical characteristics and histopathological parameters. The demographical characteristics included: sex and age of the patients, and tumor size while the histopathological aspects were divided into three subgroups: Benign, Borderline and Malignant tumors with its stromal components characteristics. All the histopathological reports for specimens sent by surgeons were reviewed by 2 senior pathologists. Statistical analysis was done by using Chi square and P-Value. Results: All our patients were females; their age range between 17-67 years, the mean patient age at presentation was 39 years. Out of the 26 patients diagnosed to have phyllodes tumor, 6 had breast-conserving therapy and 20 women had mastectomy. The types of Phyllodes tumors include: A-Benign phyllodes tumors (15 cases), B-Borderline phyllodes (7cases) and C-malignant phyllodes (4 cases). With significant values of benign tumors occurrence (pphyllodes tumors of the breast. The greatest dimension of the tumors ranged from 1 to 15 cm, with a mean of 5 cm. Approximately 73.1% of tumors were less or equal to 5 cm in the greatest dimension and 26.9% >5 cm. The duration of symptoms varied from one month to ten year.s Six patients had painful swellings, whereas in twenty patients the pain was absent. Four patients had recurrent tumors; the distinctive features of those with recurrent tumors were the histological findings of stromal over growth and the presence of positive resection margin. In our series, we found that three patients of those with recurrence discovered to have stromal over growth. While one only had a previous positive

  19. Histopathological analysis of testicular tumors

    Directory of Open Access Journals (Sweden)

    S Karki

    2012-09-01

    Full Text Available Background: Testicular cancers are rare in most countries. However, in many western countries its incidence has been increasing since the middle of the twentieth century. A definite geographic and racial distribution is seen in testicular tumors. The purpose of the study was to analyze the pattern and distribution of testicular cancers in one of the hospital in Nepal.Materials and methods: This was a retrospective study, in which cases were retrieved from the computer database between September 2006 and August 2011 in the department of Pathology. Pertinent data like age and histopathology of tumor were collected from the surgical pathology reports.Results: Testicular tumors were uncommon, comprising only 11.4% (8/70 cases of all testicular lesions. Most of these tumors (50% were seen between 4th and 5th decades. Germ cell tumors were the commonest tumors (62.5%, among which seminomas and mixed germ cell tumors were most frequently encountered, two cases each. Thirty percent of the biopsies consisted of undescended testis and none of them showed malignancy. Other tumors diagnosed were Non Hodgkin Lymphoma, leukemic infiltration and metastasis.Conclusion: Testicular tumors are uncommon in our population. As evident in other parts of the world, germ cell tumor was common in this study as well. However, unlike in Western population, no tumor was seen in undescended testis.Journal of Pathology of Nepal (2012 Vol. 2, 301-304DOI: http://dx.doi.org/10.3126/jpn.v2i4.6883

  20. Circulating tumor cells in patients with testicular germ cell tumors.

    Science.gov (United States)

    Nastały, Paulina; Ruf, Christian; Becker, Pascal; Bednarz-Knoll, Natalia; Stoupiec, Małgorzata; Kavsur, Refik; Isbarn, Hendrik; Matthies, Cord; Wagner, Walter; Höppner, Dirk; Fisch, Margit; Bokemeyer, Carsten; Ahyai, Sascha; Honecker, Friedemann; Riethdorf, Sabine; Pantel, Klaus

    2014-07-15

    Germ cell tumors (GCTs) represent the most frequent malignancies among young men, but little is known about circulating tumor cells (CTCs) in these tumors. Considering their heterogeneity, CTCs were investigated using two independent assays targeting germ cell tumor and epithelial cell-specific markers, and results were correlated with disease stage, histology, and serum tumor markers. CTCs were enriched from peripheral blood (n = 143 patients) and testicular vein blood (TVB, n = 19 patients) using Ficoll density gradient centrifugation. For CTC detection, a combination of germ cell tumor (anti-SALL4, anti-OCT3/4) and epithelial cell-specific (anti-keratin, anti-EpCAM) antibodies was used. In parallel, 122 corresponding peripheral blood samples were analyzed using the CellSearch system. In total, CTCs were detected in 25 of 143 (17.5%) peripheral blood samples, whereas only 11.5% of patients were CTC-positive when considering exclusively the CellSearch assay. The presence of CTCs in peripheral blood correlated with clinical stage (P < 0.001) with 41% of CTC positivity in patients with metastasized tumors and 100% in patients with relapsed and chemotherapy-refractory disease. Histologically, CTC-positive patients suffered more frequently from nonseminomatous primary tumors (P < 0.001), with higher percentage of yolk sac (P < 0.001) and teratoma (P = 0.004) components. Furthermore, CTC detection was associated with elevated serum levels of α-fetoprotein (AFP; P = 0.025), β-human chorionic gonadotropin (βHCG; P = 0.002), and lactate dehydrogenase (LDH; P = 0.002). Incidence and numbers of CTCs in TVB were much higher than in peripheral blood. The inclusion of germ cell tumor-specific markers improves CTC detection in GCTs. CTCs occur frequently in patients with more aggressive disease, and there is a gradient of CTCs with decreasing numbers from the tumor-draining vein to the periphery. ©2014 American Association for Cancer Research.

  1. Endoscopic mucosal resection of lateral spreading tumors of the colon using a novel solution.

    Science.gov (United States)

    Katsinelos, Panagiotis; Paroutoglou, George; Beltsis, Athanasios; Chatzimavroudis, Grigoris; Papaziogas, Basilis; Katsinelos, Taxiarchis; Rizos, Christos; Tzovaras, George; Vasiliadis, Ioannis; Dimiropoulos, Stavros

    2006-04-01

    Lateral spreading tumors (LSTs) of the colon are lesions over 10 mm in diameter that are low in height and grow superficially. They are increasingly being diagnosed in Western cohorts. The aim of this study was to investigate the safety and efficacy of dextrose 50% solution in the endoscopic mucosal resection (EMR) of LSTs. The study population consisted of 21 patients with LSTs of the colorectum. The mean size of the LSTs was 23.52+/-13.60 mm. Dextrose 50% solution was injected, via a variceal needle, into the submucosa to lift up the LST sufficiently from the proper muscle layer. Subsequently, a snare was positioned around the lesion and then closed while being pressed against the mucosa, with suction being applied to draw the lesion into the snare. Blended current was used for resection. If necessary, a piecemeal technique was used to achieve complete resection. Immediate and delayed complications were recorded. After the EMR, patients were followed up at 3, 6, and 12 months or later, using total colonoscopy. Endoscopic resection was completed in all LSTs. Of the 21 LSTs, 15 (71.4%) were resected en bloc and 6 (28.6%) piecemeal. The mean amount of injected dextrose 50% solution was 14.86+/-9.13 mL. One patient (4.78%) had immediate bleeding after EMR, which was stopped endoscopically. Histologic examination of resected LSTs showed adenoma with high-grade dysplasia 9 (42.9%), adenoma with low-grade dysplasia 10 (47.6%), and invasive carcinoma 2 (9.5%). Twenty patients were followed up for 37.9+/-24.03 months. Local recurrent disease was detected in 4 patients (20%), all within 6 months of the index EMR. These recurrent lesions were completely resected endoscopically. The contribution of submucosal injection of dextrose 50% is significant for a safe and efficient EMR of LSTs of the colorectum.

  2. Brain Tumor Epidemiology Consortium (BTEC)

    Science.gov (United States)

    The Brain Tumor Epidemiology Consortium is an open scientific forum organized to foster the development of multi-center, international and inter-disciplinary collaborations that will lead to a better understanding of the etiology, outcomes, and prevention of brain tumors.

  3. Focal midbrain tumors in children

    NARCIS (Netherlands)

    Vandertop, W. P.; Hoffman, H. J.; Drake, J. M.; Humphreys, R. P.; Rutka, J. T.; Amstrong, D. C.; Becker, L. E.

    1992-01-01

    The clinical and neuroradiological features of focal midbrain tumors in 12 children are described, and the results of their surgical management are presented. Patients with a focal midbrain tumor usually exhibit either symptoms and signs of raised intracranial pressure caused by an obstructive

  4. Radionuclide imaging of tumor angiogenesis

    NARCIS (Netherlands)

    Dijkgraaf, I.; Boerman, O.C.

    2009-01-01

    Angiogenesis is a multistep process regulated by pro- and antiangiogenic factors. In order to grow and metastasize, tumors need a constant supply of oxygen and nutrients. For growth beyond 1-2 mm in size, tumors are dependent on angiogenesis. Inhibition of angiogenesis is a new cancer treatment

  5. [Local treatment of liver tumors

    DEFF Research Database (Denmark)

    Pless, T.K.; Skjoldbye, Bjørn Ole

    2008-01-01

    Local treatment of non-resectable liver tumors is common. This brief review describes the local treatment techniques used in Denmark. The techniques are evaluated according to the evidence in literature. The primary local treatment is Radiofrequency Ablation of both primary liver tumors and liver...

  6. Surgical strategies in endocrine tumors

    NARCIS (Netherlands)

    Schreinemakers, J.M.J.

    2010-01-01

    Endocrine surgery has become more custom-made throughout the years. Endocrine tumors can be sporadic or develop as part of familial syndromes. Several familial syndromes are known to cause endocrine tumors. The most common are multiple endocrine neoplasia (MEN) syndromes type 1, 2A and 2B. This

  7. Beta-2 Microglobulin Tumor Marker

    Science.gov (United States)

    ... https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet. Accessed on 4/10/17. (January ... http://www.cancer.gov/cancertopics/factsheet/Detection/tumor-markers. Accessed June ... Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., ...

  8. Enhancing Tumor Penetration of Nanomedicines.

    Science.gov (United States)

    Sun, Qingxue; Ojha, Tarun; Kiessling, Fabian; Lammers, Twan; Shi, Yang

    2017-05-08

    Tumor-targeted nanomedicines have been extensively applied to alter the drawbacks and enhance the efficacy of chemotherapeutics. Despite the large number of preclinical nanomedicine studies showing initial success, their therapeutic benefit in the clinic has been rather modest, which is partially due to the inefficient tumor penetration caused by the tumor microenvironment (high density of cells and extracellular matrix, increased interstitial fluid pressure). Furthermore, tumor penetration of nanomedicines is significantly influenced by physicochemical characteristics, such as size, surface chemistry, and shape. The effect of size on tumor penetration has been exploited to design nanomedicines with switchable size to tackle this challenge. Moreover, several pharmacological and physical approaches have been developed to enhance the tumor penetration of nanomedicines, by penetration-promoting ligands, intratumoral drug release, and modulating the tumor microenvironment and vasculature. Overall, these efforts have resulted in nanomedicines with better tumor penetration properties and with enhanced therapeutic efficacy. Future research should be directed to penetration-promoting strategies with broad applicability and with high translational potential.

  9. Tumores cartilaginosos da laringe Cartilaginous tumors of the larynx

    Directory of Open Access Journals (Sweden)

    Robert Thomé

    2001-01-01

    Full Text Available Introdução: Os tumores cartilaginosos da laringe são raros, sendo a cartilagem cricóide a mais acometida. A raridade desses tumores tem como conseqüência experiência limitada e, portanto, o conhecimento a respeito destas neoplasias apresenta pontos obscuros. Objetivo: Apresentar os resultados cirúrgicos bem como o seguimento a longo prazo de 6 pacientes com tumores cartilaginosos da laringe, 4 condrossarcomas de baixa malignidade e 2 condromas. Forma de estudo: Retrospectivo não randomizado. Material e método: Cinco dos tumores acometiam a cartilagem cricóide e 1 a tireóide. Os pacientes foram submetidos a laringectomia parcial (4 e total (2, com seguimento de 6 a 30 anos (média-19,5 anos. Resultados: Nenhum dos pacientes apresentou metástase ou morte relacionada ao tumor. A sobrevida alcançada por 5 anos foi de 100% e a por 20 anos, 67%, sendo a comorbidade responsável por tal decréscimo. Conclusões: Nossos resultados reforçam o conceito de que a laringectomia conservadora seja a modalidade ideal de tratamento, reservando a ressecção total para tumores extensos ou casos de recorrência. Há indícios de que 5 anos pode não ser tempo suficiente para observar recorrência no condrossarcoma de baixo grau de malignidade.Introduction: Cartilaginous tumors of the larynx are uncommon, the cricoid cartilage being the most common site. The rarity of these tumors accounts for limited experience and, as a consequence, knowledge about them presents obscure points. Objective: To report surgical results as well as long-term follow-up on six patients with cartilaginous tumors of the larynx, 4 low-grade chondrosarcoma and 2 chondroma. Study design: Retrospective no randomized. Material and method: Five of the tumors were located in the cricoid and 1 in the thyroid cartilage. The patients had partial (4 and total laryngectomy (2, followed up from 6 to 30 years (average-19.5 years. Results: None of the patients presented metastasis or tumor

  10. Mitotically Active Plexiform Fibrohistiocytic Tumor

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    Ebru Zemheri

    2013-01-01

    Full Text Available Plexiform fibrohistiocytic tumor is an intermediate malignant tumor situated in superficial soft tissues. It affects children and young adults. The tumor is most commonly located on upper extremities, whereas involvement of back region is rare. Mitotic activity is generally low (~3/10 HPF. It is rare, but it can exhibit aggressive behavior, so total excision with clear surgical margins and long-term followup is necessary to detect local recurrence and metastases. We report a child with a solid mass on back region which was found to be a mitotically active plexiform fibrohistiocytic tumor (6/10 HPF after excision. Plexiform fibrohistiocytic tumor (PFT is a mesenchymal neoplasm of children, adolescents, and young adults. It is characterized by fibrohistiocytic cytomorphology and multinodular growth pattern. Clinically it is usually a slow-growing mass of upper extremities with frequent local recurrence and rare regional lymphatic and systemic metastasis (Fletcher et al. (2002, Enzinger and Zhang (1988, Remstein et al. (1999.

  11. Notch Signaling and Brain Tumors

    DEFF Research Database (Denmark)

    Stockhausen, Marie; Kristoffersen, Karina; Poulsen, Hans Skovgaard

    2011-01-01

    Human brain tumors are a heterogenous group of neoplasms occurring inside the cranium and the central spinal cord. In adults and children, astrocytic glioma and medulloblastoma are the most common subtypes of primary brain tumors. These tumor types are thought to arise from cells in which Notch...... signaling plays a fundamental role during development. Recent findings have shown that Notch signaling is dysregulated, and contributes to the malignant potential of these tumors. Growing evidence point towards an important role for cancer stem cells in the initiation and maintenance of glioma...... and medulloblastoma. In this chapter we will cover the present findings of Notch signaling in human glioma and medulloblastoma and try to create an overall picture of its relevance in the pathogenesis of these tumors....

  12. Pathogenesis and progression of fibroepithelial breast tumors

    NARCIS (Netherlands)

    Kuijper, Arno

    2006-01-01

    Fibroadenoma and phyllodes tumor are fibroepithelial breast tumors. These tumors are biphasic, i.e. they are composed of stroma and epithelium. The behavior of fibroadenomas is benign, whereas phyllodes tumors can recur and even metastasize. Classification criteria for both tumors show considerable

  13. Benign mixed tumor of the lacrimal sac

    Directory of Open Access Journals (Sweden)

    Jong-Suk Lee

    2015-01-01

    Full Text Available Neoplasms of the lacrimal drainage system are uncommon, but potentially life-threatening and are often difficult to diagnose. Among primary lacrimal sac tumors, benign mixed tumors are extremely rare. Histologically, benign mixed tumors have been classified as a type of benign epithelial tumor. Here we report a case of benign mixed tumor of the lacrimal sac.

  14. Tumors and tumor-like lesions of the heart valves

    Directory of Open Access Journals (Sweden)

    Jacob Lavee

    2009-12-01

    Full Text Available Valvular tumors and tumor-like lesions may have similar morphological and clinical characteristics, and may place the patients at a high risk of stroke in different ways. From January 2004 to June 2008, 11 patients underwent surgery for a suspected valvular tumor. Valvular tumor and tumor-like lesions accounted for 0.32% of adult cardiac operations. Five (45.5% valvular lesions were papillary fibroelastomas, one (9.1% was myxoma, 2 (18.2% were organized thrombi, and 3 (27.3% were calcification lesions. There was a total of 5 (45.5% atrioventricular valve lesions, 4 arising from the atrial side of the leaflets, and one from the ventricular side. All 5 (45.5% semilunar valvular lesions were from the aortic valve. One (9.1% lesion originated from the chorda tendinea of the mitral valve. All leaflet lesions were resected by a simple shave technique, and all the patients recovered favorably. Valvular tumor and tumor-like lesions are rare. Pre-operative differential diagnoses among these valvular lesions pose important clinical implications for appropriate treatment for the underlying diseases. Prompt therapeutic measures in view of the underlying diseases of the valvular lesions are essential to prevent potential embolic events.

  15. IMRT in hypopharyngeal tumors

    Energy Technology Data Exchange (ETDEWEB)

    Studer, G.; Luetolf, U.M.; Davis, J.B.; Glanzmann, C. [Dept. of Radiation Oncology, Univ. Hospital, Zurich (Switzerland)

    2006-06-15

    Background and purpose: intensity-modulated radiation therapy (IMRT) data on hypopharyngeal cancer (HC) are scant. In this study, the authors report on early results in an own HC patient cohort treated with IMRT. A more favorable outcome as compared to historical data on conventional radiation techniques was expected. Patients and methods: 29 consecutive HC patients were treated with simultaneous integrated boost (SIB) IMRT between 01/2002 and 07/2005 (mean follow-up 16 months, range 4-44 months). Doses of 60-71 Gy with 2.0-2.2 Gy/fraction were applied. 26/29 patients were definitively irradiated, 86% received simultaneous cisplatin-based chemotherapy. 60% presented with locally advanced disease (T3/4 Nx, Tx N2c/3). Mean primary tumor volume measured 36.2 cm{sup 3} (4-170 cm{sup 3}), mean nodal volume 16.6 cm{sup 3} (0-97 cm{sup 3}). Results: 2-year actuarial local, nodal, distant control, and overall disease-free survival were 90%, 93%, 93%, and 90%, respectively. In 2/4 patients with persistent disease (nodal in one, primary in three), salvage surgery was performed. The mean dose to the spinal cord (extension of > 5-15 mm) was 26 Gy (12-38 Gy); the mean maximum (point) dose was 44.4 Gy (26-58.9 Gy). One grade (G) 3 dysphagia and two G4 reactions (laryngeal fibrosis, dysphagia), both following the schedule with 2.2 Gy per fraction, have been observed so far. Larynx preservation was achieved in 25/26 of the definitively irradiated patients (one underwent a salvage laryngectomy); 23 had no or minimal dysphagia (G0-1). Conclusion: excellent early disease control and high patient satisfaction with swallowing function in HC following SIB IMRT were observed; these results need to be confirmed based on a longer follow-up period. In order to avoid G4 reactions, SIB doses of < 2.2 Gy/fraction are recommended for large tumors involving laryngeal structures. (orig.)

  16. Essential contribution of tumor-derived perlecan to epidermal tumor growth and angiogenesis

    DEFF Research Database (Denmark)

    Jiang, Xinnong; Multhaupt, Hinke; Chan, En

    2004-01-01

    As a major heparan sulfate proteoglycan (PG) in basement membranes, perlecan has been linked to tumor invasion, metastasis, and angiogenesis. Here we produced epidermal tumors in immunocompromised rats by injection of mouse RT101 tumor cells. Tumor sections stained with species-specific perlecan...... factor. In vivo, antisense perlecan-transfected cells generated no tumors, whereas untransfected and vector-transfected cells formed tumors with obvious neovascularization, suggesting that tumor perlecan rather than host perlecan controls tumor growth and angiogenesis....

  17. Keratocystic odontogenic tumor

    Directory of Open Access Journals (Sweden)

    BRENDA DE SOUZA MOURA

    Full Text Available ABSTRACT Objective: to evaluate the frequency of keratocystic odontogenic tumor (KOT in the Oral Surgery Service (OSS of the University Hospital Clementino Fraga Filho of the Federal University of Rio de Janeiro (HUCFF / UFRJ, with respect to recurrence rate, gender, age of recurrence and location of the injury Methods: clinical records were reviewed and histopathological reports of KOT patients of the HUCFF/UFRJ between 2002 and 2012. Patients diagnosed with KOT were divided into two groups for the occurrence of relapse: positive (n=6 and negative (n=19 Results: regarding the location, there was a predilection for the mandible. In the average age of patients in the positive group was 40.5 and the negative group, 35.53. In the distribution by gender, positive group showed equal distribution, different from that observed in the negative group, which showed a predilection for males Conclusion: KOT was the second most frequent injury in our patients, recurrence was lower among males and had the jaw as most affected location

  18. Cushing syndrome due to adrenal tumor

    Science.gov (United States)

    Adrenal tumor - Cushing syndrome ... Cushing syndrome is a disorder that occurs when your body has a higher than normal level of ... or cancerous (malignant). Noncancerous tumors that can cause Cushing syndrome include: Adrenal adenomas, a common tumor that ...

  19. Tumor-suppressing gene therapy.

    Science.gov (United States)

    Fang, Bingliang; Roth, Jack A

    2003-01-01

    Tumor-suppressor genes play pivotal roles in maintaining genome integrity and in regulating cell proliferation, differentiation, and apoptosis. Their loss-of-function mutations are related directly to tumorigenesis. Thus, use of tumor-suppressor genes as anticancer therapeutics has been investigated rigorously in both experimental and clinical researches. Transfer of various tumor-suppressor genes directly to cancer cells has been demonstrated to suppress tumor growth via induction of apoptosis and cell-cycle arrest and, in some cases, with evidence for bystander effects. Various studies also have shown that combination of tumor-suppressor gene therapy with conventional anticancer therapy can yield synergistic therapeutic benefits. Clinical trials with tumor-suppressor genes, especially the p53 gene, have demonstrated that the treatment is well tolerated, and; favorable clinical responses, including a pathologically complete responses, have been observed in a subset of patients with advanced disease or with cancers resistant to conventional therapy. Yet, current gene replacement approaches in cancer gene therapy must be improved if they are to have a broader clinical impact. Efficient systemic gene delivery systems will be required ultimately for treatment of metastatic disease. In this review, we have recently summarized achievements in tumor-suppressor gene therapy with a focus on the p53 gene.

  20. Tumor targeting via integrin ligands

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    Udaya Kiran eMarelli

    2013-08-01

    Full Text Available Selective and targeted delivery of drugs to tumors is a major challenge for an effective cancer therapy and also to overcome the side effects associated with current treatments. Overexpression of various receptors on tumor cells is a characteristic structural and biochemical aspect of tumors and distinguishes them from physiologically normal cells. This abnormal feature is therefore suitable for selectively directing anticancer molecules to tumors by using ligands that can preferentially recognize such receptors. Several subtypes of integrin receptors that are crucial for cell adhesion, cell signaling, cell viability and motility have been shown to have an upregulated expression on cancer cells. Thus, ligands that recognize specific integrin subtypes represent excellent candidates to be conjugated to drugs or drug carrier systems and be targeted to tumors. In this regard, integrins recognizing the RGD cell adhesive sequence have been extensively targeted for tumor specific drug delivery. Here we review key recent examples on the presentation of RGD-based integrin ligands by means of distinct drug delivery systems, and discuss the prospects of such therapies to specifically target tumor cells.