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Different options of endosonography-guided biliary drainage after endoscopic retrograde cholangiopancreatography failure

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World Journal of Gastrointestinal Endoscopy 2018年第5期10卷 99-108页

作者： Josécelso Ardengh césar vivian lopes Rafael Kemp Jose Sebastiao dos Santos Division of Surgery and Anatomy Ribeirao Preto Medical SchoolUniversity of Sao PauloRibeirao PretoSao Paulo 14049-900Brazil Department of Gastroenterology and Digestive Endoscopy Santa Casa HospitalPorto Alegre 91410-000Brazil

AIM To investigate the success rates of endosonography(EUS)-guided biliary drainage(EUS-BD) techniques after endoscopic retrograde cholangiopancreatography(ERcP) failure for management of biliary *** From Feb/2010 to Dec/2016, ERcP was performed in 3538 patients, 24 of whom(0.68%) suffered failure to cannulate the biliary tree. All of these patients were initially submitted to EUS-guided rendez-vous(EUS-RV) by means of a transhepatic approach. In case of failure, the next approach was an EUS-guided anterograde stent insertion(EUS-ASI) or an EUS-guided hepaticogastrostomy(EUS-HG). If a transhepatic approach was not possible or a guidewire could not be passed through the papilla, EUS-guided choledochoduodenostomy(EUS-cD) was *** Patients were submitted to EUS-RV(7), EUS-ASI(5), EUS-HG(6), and EUS-cD(6). Success rates did not differ among the various EUS-BD techniques. Overall,technical and clinical success rates were 83.3% and 75%, respectively. Technical success for each technique was, 71.4%, 100%, 83.3%, and 83.3%, respectively(P = 0.81). complications occurred in 3(12.5%) patients. All of these cases were managed conservatively, but one patient died after rescue percutaneous transhepatic biliary drainage(PTBD).cONcLUSION The choice of a particular EUS-BD technique should be based on patient's anatomy and on whether the guidewire could be passed through the duodenal papilla.

关键词： cholestasis Drainage Endosonography Interventional procedures Jaundice Neoplasms

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

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World Journal of Gastroenterology 2007年第22期13卷 3112-3116页

作者： José celso Ardengh césar vivian lopes Luiz Felipe Pereira de Lima Juliano Rodrigues de Oliveira Filadélfi o Venco Giulio cesare Santo José Luiz Pimenta Módena Echoendoscopy and Pathology Units from 9 de Julho Hospital and Ribeiro Preto Medical School-USP So Paulo Brazil

AIM： To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration （EUS-FNA） for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions.METHODS： From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUSFNA. The final diagnosis was obtained either by surgery （356 cases） or after a mean clinical follow-up of 11.8 mo in the remaining patients.RESULTS： There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 （97.4%） cases. There were 352 （57.6%） malignancies and 259 （42.4%） benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67% of the lesions. Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4%, 99.2%, 99.3%, 77.2% and 87.2%. Specifically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8% ys 82.4%, 100% ys 98.4%, 100% vs 99%, 54.8% vs 74.1% and 83.1% vs 87.8%. For cystic lesions, the values were, respectively, 72.2%, 99.3%, 97.5%, 91% and 92.2%.cONcLUSION： EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions can reveal the best negative predictive value and diagnostic accuracy, both higher than 90%.

关键词： Diagnosis Endoscopic ultrasound Fineneedle-aspiration biopsy Pancreas cancer Pancreatic disease Sampling

Endoscopic resection of superficial gastrointestinal tumors

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World Journal of Gastroenterology 2008年第29期14卷 4600-4606页

作者： Giovannini Marc cesar vivian lopes Endoscopic Unit Paoli-Calmettes Institute232 Bd St-Marguerite Cedex 13273 France

Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.

关键词： Superficial gastrointestinal cancers Endoscopic mucosal resection Endoscopic submucosaldissection Lymph node spreading Esophagus Stomach colorectal

Perceived Efficacy of Vaginal Dryness Relief: A comparative clinical Study between Sodium hyaluronate vaginal gel1vs. Promestriene cream2

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Advances in Sexual Medicine 2017年第1期7卷 34-43页

作者： Eduardo de Oliveira Duque-Estrada vivian Pessoto Rosa Mariane Martins Mosca Heliara lopes do Nascimento Hospital Municipal Dr. Moysés Deutsch S&atilde o Paulo Brazil Allergisa cRO Team S&atilde o Paulo Brazil

In the study, we report the comparative efficacy of the sodium hyaluronate gel vaginal application and promestriene cream which were tested to treat the gynecological symptoms of people who suffered from vaginal dryness. Method: 35 patients applied sodium hyaluronate vaginal gel one time a day for a period of two times a week during three weeks and other 33 patients using promestriene cream applied it every day for a period of three weeks also. Results: No significant difference was observed between vaginal application of sodium hyaluronate gel and promestriene cream, regarding both, as regarding the dryness of the intimate mucosa (p = 0.786), the attribute of moisturizing properties to the intimate mucosa (p = 0.142), the comfort sensation (p = 0.528), and no significant difference was observed regarding the fragrance of the product (p = 0.088). conclusion: The similar results between vaginal application of both products support the use of sodium hyaluronate vaginal gel (Lubrinat®) in the initial approach of symptoms of vaginal dryness.

关键词： Vaginal Dryness Menopause Sodium Hyaluronate Promestriene