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Contrast-enhanced harmonic endoscopic ultrasound imaging: Basic principles, present situation and future perspectives

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World Journal of Gastroenterology 2014年第42期20卷 15549-15563页

作者： María-Victoria Alvarez-Sánchez Bertrand Napoléon department of Gastroenterology H?pital Privé Jean Mermoz department of Gastroenterology Complejo Hospitalario de Pontevedra

Over the last decade, the development of stabilised microbubble contrast agents and improvements in available ultrasonic equipment, such as harmonic imaging, have enabled us to display microbubble enhancements on a greyscale with optimal contrast and spatial resolution. Recent technological advances made contrast harmonic technology available for endoscopic ultrasound(EUS) for the first time in 2008. Thus, the evaluation of microcirculation is now feasible with EUS, prompting the evolution of contrast-enhanced EUS from vascular imaging to images of the perfused tissue. Although the relevant experience is still preliminary, several reports have highlighted contrast-enhanced harmonic EUS(CHEUS) as a promising noninvasive method to visualise and characterise lesions and to differentiate benign from malignant focal lesions. Even if histology remains the gold standard, the combination of CH-EUS and EUS fine needle aspiration(EUS-FNA) can not only render EUS more accurate but may also assist physicians inmaking decisions when EUS-FNA is inconclusive,increasing the yield of EUS-FNA by guiding the puncture with simultaneous imaging of the *** development of CH-EUS has also opened up exciting possibilities in other research areas,including monitoring responses to anticancer chemotherapy or to ethanolinduced pancreatic tissue ablation,anticancer therapies based on ultrasound-triggered drug and gene delivery,and therapeutic adjuvants by contrast ultrasound-induced *** harmonic imaging is gaining popularity because of its efficacy,simplicity and noninvasive nature,and many expectations are currently resting on this *** its potential is confirmed in the near future,contrast harmonic imaging will become a standard practice in EUS.

关键词： Microbubbles Contrast agents Contrast-enhanced harmonic endoscopic ultrasound Pancreatic tumour Gastrointestinal submucosal tumour

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New horizons in the endoscopic ultrasonography-based diagnosis of pancreatic cystic lesions

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World Journal of Gastroenterology 2018年第26期24卷 2853-2866页

作者： María-Victoria Alvarez-Sánchez Bertrand Napoléon Instituto de Investigación Sanitaria Galicia Sur Complejo Hospitalario Universitario de Pontevedra department of Gastroenterology Ramsay Générale de Santé Private Hospital Jean Mermoz

Pancreatic cystic lesions(PCLs) are increasingly being identified because of the widespread use of highresolution abdominal imaging. These cysts encompass a spectrum from malignant disease to benign lesions, and therefore, accurate diagnosis is crucial to determine the best management strategy, either surgical resection or surveillance. However, the current standard of diagnosis is not accurate enough due to limitations of imaging and tissue sampling techniques, which entail the risk of unnecessary burdensome surgery for benign lesions or missed opportunities of prophylactic surgery for potentially malignant PCLs. In the last decade, endoscopic innovations based on endoscopic ultrasonography(EUS) imaging have emerged, aiming to overcome the present limitations. These new EUS-based technologies are contrast harmonic EUS, needle-based confocal endomicroscopy, through-the-needle cystoscopy and through-the needle intracystic biopsy. Here, we present a comprehensive and critical review of these emerging endoscopic tools for the diagnosis of PCLs, with a special emphasis on feasibility, safety and diagnostic performance.

关键词： Intraductal papillary mucinous neoplasm Pancreatic cystic lesions Endoscopic ultrasonography Confocal endomicroscopy Mucinous cystadenoma Through-the-needle cystoscopy Serous cystadenoma Through-the-needle forceps biopsy Contrast harmonic endoscopic ultrasonography

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Review of endoscopic radiofrequency in biliopancreatic tumours with emphasis on clinical benefits, controversies and safety

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World Journal of Gastroenterology 2016年第37期22卷 8257-8270页

作者： María-Victoria Alvarez-Sánchez Bertrand Napoléon department of Gastroenterology Complejo Hospitalario Universitario de Pontevedra Instituto de Investigación Sanitaria Galicia Sur department of Gastroenterology Ramsay Générale de Santé Private Hospital Jean Mermoz

Most pancreatic cancers and extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis, and even in case of a resectable cancer, for elderly or patients with coexistent comorbidities, surgery is not an option. Current treatment alternatives in these scenarios are very limited. Biliary stenting with selfexpanding metal stents(SEMS) is the mainstay palliative treatment of biliary obstruction due to unresectable pancreatic cancer or cholangiocarcinoma. Nevertheless, more than 50% of SEMS become occluded after 6 mo due to tumour over- and ingrowth, leading to hospital readmissions and reinterventions that significantly impair quality of life. Regimes of chemotherapy or chemoradiotherapy also provide minimal survival benefits. Therefore, novel therapies are eagerly awaited. Radiofrequency(RF) energy causes coagulative necrosis leading to local destruction of the accessed malignant tissue and has an established role in the treatment of malignancies in several solid organs, especially liver cancers. However, pancreatic and extrahepatic biliary cancers are not easily accessed by a percutaneous route, making the procedure dangerous. Over the past five years, the development of dedicated devices compatible with endoscopic instruments has offered a minimally invasive option for RF energy delivery in biliopancreatic cancers. Emerging experience with endoscopic RF ablation(RFA) in this setting has been reported in the literature, but little is known about its feasibility, efficacy and safety. A literature review makes it clear that RFA in biliopancreatic tumours is feasible with high rates of technical success and acceptable safety profile. Although available data suggest a benefit of survival with RFA, there is not enough evidence to draw a firm conclusion about its efficacy. For this reason, prospective randomized trials comparing RFA with standard palliative treatments with quality-of-life and survival endpoints are required. Anecdotal reportshave also highlig

关键词： Radiofrequency ablation Pancreatic tumour Endobiliary radiofrequency Cholangiocarcinoma Biliary stricture

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ECIEN-2020 study:the effect of COVID-19 on admissions for non-COVID-19 diseases

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World Journal of Pediatrics 2021年第1期17卷 85-91页

作者： Beatriz Ramos-Lacuey Mercedes Herranz Aguirre Clara Calderón Gallego Andrea Ilundain López de Munain Eva Gembero Esarte Laura Moreno-Galarraga department of Pediatrics CHNComplejo Hospitalario de NavarraServicio Navarro de SaludC/Irunlarrea 331080 PamplonaSpain Pediatric Infectious Diseases department CHNComplejo Hospitalario de NavarraServicio Navarro de SaludPamplonaSpain Pediatric Hospitalization Department of PediatricsCHNComplejo Hospitalario de NavarraServicio Navarro de SaludPamplonaSpain IdiSNA Navarra Institute for Health ResearchPamplonaSpain department of Preventive Medicine and Public Health School of MedicineUniversity of NavarraPamplonaSpain Pediatric Pulmonology Department of PediatricsCHNComplejo Hospitalario de NavarraServicio Navarro de SaludPamplonaSpain

Background The pandemic caused by severe acute respiratory coronavirus 2(SARS-CoV-2)has had great effects on health systems worldwide,not only in relation to coronavirus disease 2019(COVID-19)cases but also affecting patients with other *** ECIEN-2020 is an observational study conducted in a tertiary referral hospital in Navarra,*** describes the effects of COVID-19 pandemic and the preventive measures adopted,in pediatric admissions for non-COVID-19 *** during March-June 2020(first wave of the COVID-19 pandemic in Spain)are described and compared with the same quarter in 2019.A sub-analysis was performed delving into *** characteristics(age,sex,past medical history),disease characteristics(symptoms,duration of symptoms,previous consultation in Primary Care Health Center),and admission characteristics(place and average stay)were *** A 33% reduction in the number of pediatric hospital admissions was observed,decreasing from 529 hospitaliza-tions in 2019 to 353 in 2020(Pdepartment rose from 5.1%in 2019 to 10.9% in 2020,whereas the total number of consultations in the emergency department decreased by 68%.Conclusion The pandemic and the measures adopted due to SARS-CoV-2 have significantly decreased pediatric admissions for non-COVID-19 diseases,especially due to a reduction in the hospitalization for respiratory diseases.

关键词： Admission COVID-19 Hospitalization SARS-CoV-2

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Gonadotrophin-releasing hormone agonist-induced pituitary adenoma apoplexy and casual finding of a parathyroid carcinoma:A case report and review of literature

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World Journal of Clinical Cases 2019年第20期7卷 3259-3265页

作者： Vanessa Trivino Olga Fidalgo Antía Juane Jorge Pombo Fernando Cordido department of Endocrinology Complejo Hospitalario Universitario A CorunaA Coruna 15006Spain department of pathological anatomy Complejo Hospitalario Universitario A CorunaA Coruna 15006Spain

BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate ***-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in those patients who have insidious pituitary adenoma *** SUMMARY A 46-year-old woman,with a history of hypertension and menorrhagia was transferred to our hospital from a secondary care hospital after complaints of headache and vomiting,with loss of consciousness 5 min after an injection of *** drug was prescribed by her gynecologist due to the presence of uterine *** clinical neurological examination revealed right cranial nerve III palsy,ptosis and movement limitation of the right *** first clinical consideration was a pituitary *** hormonal analysis revealed mild hyperprolactinemia and high follicle stimulating hormone level;PTH and calcium was high with glomerular filtration rate mildly to moderately decrease.A computed tomography scan,revealed an enlarged pituitary gland(3.5 cm)impinging upon the optic chiasm with bone involvement of the *** contrast media administration,the lesion showed homogeneous enhancement with high-density focus that suggests hemorrhagic infarction of the *** endoscopic surgery was perfomed and adenomatous tissue was *** was positive for luteinizing hormone(LH)and follicular-stimulating hormone(FSH).A solid hypoechoic nodule(14 mm x 13 mm x 16 mm)was found in the caudal portion of the right thyroid lobe after a parathyroid ultrasound.A genetic test of Multiple Endocrine Neoplasia type 1(MEN1)was negative.A right lower parathyroidectomy was performed and the pathologic study showed the presence of an encapsulated parathyroid carcinoma of 1.5 cm.A MEN type 4 genetic test was performed result was *** This case demonstrates an uncommon complication of GnRH agonist therapy in the setting of a pituitary macroadenoma an

关键词： Pituitary apoplexy Pituitary adenoma Primary hyperparathyroidism MEN type 1 MEN type 4 Parathyroid carcinoma Case report

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Primary malignant melanoma of the biliary tract: A case report and literature review

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World Journal of Clinical Cases 2019年第16期7卷 2302-2308页

作者： Soledad Cameselle-García José Luis Fírvida Pérez María C Areses Jesús Daniel Fernández de Castro Juan Mosquera-Reboredo Jesús García-Mata department of Medical Oncology Complejo Hospitalario Universitario de OurenseSERGASOurense 32005Spain department of Digestive Complejo Hospitalario Universitario de OurenseSERGASOurense 32005Spain department of Pathology Hospital San RafaelA Coruna 15009Spain

BACKGROUND Primary malignant melanoma of the biliary tract (MBT) is a rare condition whose diagnosis requires excluding a primary origin in another *** paper reviews the most important characteristics of MBT cases published in the literature and reports a new *** patient reported here is the first case of primary malignant melanoma of the biliary tract with pulmonary metastasis treated with *** patient remains disease-free 36 mo after the treatment of metastatic lung *** SUMMARY A 51-year-old man was admitted to the gastrointestinal department to study obstructive jaundice of a 1 wk clinical *** resonance cholangiopancreatography revealed dilatation of the intrahepatic biliary tract and stenosis of the common hepatic *** the suspicion of biliary tract neoplasia,cholecystectomy and resection of the common hepatic duct were performed with hepatic jejunostomy free of ***-pathological diagnosis was *** intervention,the patient was referred to the department of Medical Oncology,where a primary origin was excluded in the skin,mucosa,and *** confirmed diagnosis of primary biliary tract *** tomography was performed 12 mo after the procedure revealed several subcentimetric lung *** resection was *** confirming the diagnosis of pulmonary metastasis of primary melanoma of the biliary tract,the patient was started on immunotherapy with *** to treatment was *** patient remains disease-free 36 mo after the treatment of metastatic lung *** The patient reported here is the first case of primary malignant melanoma of the biliary tract with lung metastases successfully treated with immunotherapy.

关键词： Biliary tract Case report Immunotherapy Malignant melanoma

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Diagnostic performance of serum interleukin-6 in pediatric acute appendicitis:a systematic review

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World Journal of Pediatrics 2022年第2期18卷 91-99页

作者： Javier Arredondo Montero Carlos Bardaji Pascual Monica Bronte Anaut Natalia Lopez-Andres Giuseppa Antona Nerea Martin-Calvo Pediatric Surgery department Complejo Hospitalario de NavarraCalle Irunlarrea 331008 PamplonaNavarraSpain Pathology department Complejo Hospitalario de NavarraPamplonaSpain Cardiovascular Translational Research Navarrabiomed(Miguel Servet Foundation)Complejo Hospitalario de Navarra(CHN)Universidad Publica de Navarra(UPNA)IdiSNAPamplonaSpain department of Preventive Medicine and Public Health Instituto de Investigacion Sanitaria de Navarra(IdiSNA).University of Navarra.PamplonaSpain CIBER Fisiopatologia de la Obesidad y Nutricion(CIBERobn) Health Institute CarlosⅢMadridSpain

Background despite the radiological and analytical advances of the last decades,there is still a significant rate of diagnostic error in pediatric acute *** recent years,multiple biomarkers have emerged as potential diagnostic *** study aimed to examine the diagnostic performance of serum interleukin-6 in pediatric acute *** We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography(Medline,PubMed,Web of Science and SciELO).Two independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion *** quality of the selected article was rated using the QUADAS2 *** extraction was performed by two independent *** The research in the medical bibliography databases resulted in 68 *** removed 26 *** the remaining 42 articles,we excluded 33 following the inclusion and exclusion *** the final 9 studies included in this review,8 provided measured serum interleukin-6 values,and all of them reported significant differences between groups,but inconsistent results regarding sensitivity and *** The diagnostic performance of interleukine-6 alone for the diagnosis of acute appendicitis in children is *** sensitivity and specificity of interleukine-6 for the diagnosis of non-complicated acute appendicitis in the pediatric population are moderate but increased in complicated *** seems to be a direct relationship between serum level of interleukin-6 and the hours of evolution of abdominal pain in children with acute *** increasingly widespread use of non-operative management of acute appendicitis warrants further exploration of the classificatory potential of this marker between complicated and uncomplicated *** consider that this may be an avenue of research to explore in the future.

关键词： Acute appendicitis Children Interleukin-6 Pediatric Sensitivity Specificity Systematic review

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Auricular embryonal rhabdomyosarcoma

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World Journal of Pediatrics 2022年第5期18卷 358-360页

作者： Javier Arredondo Montero Monica Bronte Anaut Sara Hernandez-Martin Juan Carlos Lopez-Gutierrez Pediatric Surgery department Complejo Hospitalario de NavarraCalle Irunlarrea 331008 PamplonaNavarraSpain Pathology department Complejo Hospitalario de NavarraPamplonaSpain Pediatric Surgery department Hospital Universitario La PazMadridSpain

A 13-month-old girl presented with a red-violaceous tumor of 13 mm in diameter on the inner side of the root of the right helix,with increased temperature and cystic consistency(Fig.1).No pulse was palpable in the *** ultrasonography was performed,showing a 1.6 cm rounded lesion with well-defined margins,hypoechogenic and homogeneous,compatible with *** treatment with oral propranolol was started without improve-ment.

关键词： sarcoma ultrasonography showing

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Reconstruction after pancreatoduodenectomy:Pancreatojejunostomy vs pancreatogastrostomy

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World Journal of Gastrointestinal Oncology 2014年第9期6卷 369-376页

作者： Tatiana Gómez Ana Palomares Mario Serradilla Luis Tejedor department of Surgery Hospital Punta de Europa Division of Hepato-Pancreatic-Biliary Surgery Department of SurgeryComplejo Hospitalario de Jaén

Pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy(PD) in order to decrease postoperative complications,mainly pancreatic fistulas(PF).In this work,we compare the two most frequent techniques of reconstruction after PD,pancreatojejunostomy(PJ) and pancreatogastrostomy(PG),in order to determine which of the two is better.A systematic review of the literature was performed,including major meta-analysis articles,clinical randomized trials,systematic reviews,and retrospective studies.A total of 64 articles were finally *** and PG are usually responsible for most of the postoperative morbidity,mainly due to the onset of PF,being considered a major trigger of life-threatening complications such as intra-abdominal abscess and *** included systematic reviews reported a significant difference only in the incidence of intraabdominal collections favouring ***,delayed gastric emptying and mortality were not *** there was heterogeneity between these studies,all were conducted in specialized centers by highly experienced surgeons,and the surgical care was likely to be similar for all the *** disadvantages of PG include an increased incidence of delayed gastric emptying and of main pancreatic duct obstruction due to overgrowth by the gastric *** function appears to be worse after PG than after PJ,resulting in severe atrophic changes in the remnant *** on the type of PJ or PG used,the PF rate and other complications can also be *** best method to deal with the pancreatic stump after PD remains *** choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles such as good exposure and *** conclusion,up to now none of the techniques can be considered superior or be recommended as standard for reconstruction after PD.

关键词： Pancreatoduodenectomy Pancreatojeju-nostomy Pancreatogastrostomy Pancreatic fistula Pancreatic cancer Surgical technique

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Endoluminal solutions to bariatric surgery complications:A review with a focus on technical aspects and results

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World Journal of Gastrointestinal Endoscopy 2017年第3期9卷 105-126页

作者： Raquel Souto-Rodríguez María-Victoria Alvarez-Sánchez department of Gastroenterology Complejo Hospitalario Universitario de PontevedraInstituto de Investigación Sanitaria Galicia Sur36071 PontevedraSpain

Obesity is a growing problem in developed countries,and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese *** the advances in surgical techniques,some patients still develop acute and late postoperative complications,and an endoscopic evaluation is often required for ***,the high morbidity related to surgical reintervention,the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery,and,in many cases,a suitable first-line treatment of bariatric surgery *** is now evidence in the literature supporting endoscopic management for some of these complications,such as gastrointestinal bleeding,stomal and marginal ulcers,stomal stenosis,leaks and fistulas or pancreatobiliary ***,endoscopic treatment in this setting is not standardized,and there is no consensus on its optimal *** this article,we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic *** on a thorough review of the literature,we evaluated the performance and safety of different endoscopic options for every type of complication,highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

关键词： Bariatric surgery Bariatric complications Endoscopic treatment Leaks Stenosis Sleeve gastrectomy Gastric Roux-en-Y bypass

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