No abstract

RESUMEN: El Paraíso es uno de los departamentos menos estudiados en Honduras. Añadimos ocho especies de lagartijas y serpientes a su listado de especies reptilianas y presentamos datos morfológicos de un espécimen de la poco recolectada Agkistrodon howardgloydi. Las localidades contempladas aquí contienen algunos de los remanentes mejor preservados de bosque árido de bajura y bosque seco premontano en Honduras. Sugerimos que se realicen inventarios de fauna y planes de gestión para la protección de las zonas de vegetación restantes localizadas en la región de El Paraíso. PALABRAS CLAVE: El Paraíso, Honduras, bosque seco de tierras bajas, bosques secos, lagartijas, serpientes, Agkistrodon howardgloydi.

Background and study aims Submucosal (SM) injection is a critical step in endoscopic submucosal dissection (ESD). In Japan, use of viscous solutions such as sodium hyaluronate are recommended; the commercially product available is MucoUp (Seikagaku Co. and Boston Scientific Japan Co., Japan). Nevertheless, MucoUp is expensive and unavailable in many Western countries. For the past 8 years, we have been using low-cost sterile teardrops solution composed of 0.4 % sodium hyaluronate (Adaptis Fresh, Legrand Laboratory, Brazil). This solution is readily available in drugstores with a cost of approximately US$ 10.00 for each 10-cc bottle. The aim of this study was to present the clinical outcome with off-label sodium hyaluronate use for SM injection in gastric ESD. Patients and methods A single-center retrospective study of collected data investigating consecutive patients that underwent gastric ESD between 2012 and 2019. ESD was performed using 0.4 % sodium hyaluronate teardrop for SM injection and Flush Knife BT 2.5 (Fujifilm Co., Japan). The following data were analyzed: clinical-pathological features, en-bloc, R0 and curative resection rate, procedure duration, adverse events, and clinical outcome. Results ESD was performed with sodium hyaluronate for submucosal injection in 78 patients. The en-bloc resection rate and R0 resection rate were 96.1 % and 92.3 %, respectively. The curative resection rate for epithelial lesions was 83.8 %. Adverse events occurred in 5 cases (6.3 %): delayed bleeding (3.8 %, 3 cases) and perforation (2.5 %, 2 cases); all managed successfully by clipping and thermal coagulation. The mean volume of sodium hyaluronate solution used per patient was 10 cc (SD: ± 8 cc). During follow-up (mean: 17 months; SD: ± 14.5 months), two patients developed metachronous lesions (2.5 %). Conclusions Off-label use of teardrops with 0.4 % sodium hyaluronate for submucosal injection was demonstrated to be safe and able to provide an effective submucosal cushion that facilitates SM dissection in gastric ESD procedures.

No abstract

Malignant melanoma is the neoplasm that most frequently produces metastasis at the gastrointestinal tract. Metastatic lesions can be found in the small bowel in 50 to 60% of the necropsies of patients who die due to malignant melanoma; however, the diagnosis of metastasis in vivo is achieved in less than 10% of patients with this clinical entity. The capsule endoscopy is considered an excellent non-invasive diagnostic method for the evaluation of the small bowel in this group of patients. All patients with melanoma history and gastrointestinal tract hemorrhage, iron deficiency anemia, abdominal pain and / or unexplained weight loss should perform an capsule endoscopy to rule out small bowel involvement. We present two patients with cutaneous melanoma with apparent remission who develop iron-deficiency anemia, without a history of evident gastrointestinal bleeding with negative endoscopic examinations and capsule endoscopy findings of intestinal metastasis due to melanoma.