Spraying with Sodium Thiosulphate Solution (STSS, Detoxol®) is reported to be useful in reducing the side effects of Iodine dyeing on the esophagus. In order to determine the optimal concentration of STSS and its efficacy, STSS was administered in the following concentrations. Group A: 10% (Original Solution), Group: B 5%. Group C, 2.5%. Group D: 1.7% and Group E: saline with no STSS, and a questionnaire was conducted to assess the side effects. The results showed that the higher the concentration, the less frequent and short lasting the side effects were. The effects of STSS on diagnostic efficacy was also evaluated. After spraying with STSS, the 2.5% solution removed iodine gradually but there were differences in discoloration among the various degrees of inflammation. When iodine dyeing was repeated, clear images with a good contrast were obtained. Excess iodine was neutralized and details of the surface and vascular pattern were more readily observed. Spraying with STSS seemed to increase the diagnostic ability of the procedure.
Percutaneous endoscopic gastrostomy (PEG) is the standard modality for long-term enteral nutrition; however, complications are common. To avoid these complications, we introduce laparoscopic-assisted PEG (LAPEG) and describe its advantages. The aim of this study was to describe the advantages of LAPEG relative to other procedures. We retrospectively reviewed the records of 19 patients who underwent LAPEG at our institution from June 2008 to February 2013. They were thought to be difficult cases for PEG. LAPEG was successfully performed in 18 patients (average age, 78.5 years; range, 50-98 years). The average surgical duration was 32.4 ± 6.2 minutes. No major intraoperative or postoperative complications were observed. Feeding tubes were successfully placed in all patients within some days. LAPEG is a safe, effective, and simple procedure. The strongest advantage of LAPEG is the possibility of observing the intraperitoneal condition and the ability to perform PEG safely without any complications. LAPEG should be the first-choice procedure if it is difficult to accomplish conventional PEG.
We report a very rare case of mucoepidermoid carcinoma (MEC) of the esophagus. The patient was a 47-year-old man with a tumor of the submucosal type, associated with erosion on its top in the mid-esophagus, detected by esophagoscopy. The lesion was stained with 3% iodine solution, but the site of the erosion was not. Endoscopic ultrasonography revealed a hypo-echogenic tumor located mainly in the submucosal layer, preserving the muscle coat intact. Distal esophagectomy with esophago-gastrostomy was performed via the retrosternal route. Microscopic study revealed the lesion to be compatible with a mucoepidermoid cancer (0-1 sep type, sm massive invasion, ly2, v0, n3 (+) based on the classification of the Japanese Society of Esophageal Diseases). The diagnosis of MEC is very difficult, because this lesion grows and develops like a submucosal tumor. Considering this feature of MEC, endoscopic ultrasonography must be carried out for small submucosal tumors of the esophagus in order to detect MEC. Clarification of the endoscopic ultrasonographic characteristics of MEC is eagerly awaited. (Dig Endosc 1998 ; 10 : 51 -54)
: An aneurysm of the abdominal internal organs is relatively rare. Recently, segmental arterial mediolysis SAM and median arcuate ligament syndrome MALS were identi ed as speci c causes for aneurysms of the pancreaticoduodenal artery arcade. Herein, we report a ruptured anterior superior pancreaticoduodenal artery ASPDA aneurysm due to SAM that was misdiagnosed as acute pancreatitis. The patient was a 59-year-old male with acute, severe, and sharp pain in the upper abdomen. He was clinically diagnosed with acute pancreatitis based on abdominal computed tomography CT . However, a follow-up CT scan revealed an aneurysm of the ASPDA. We therefore diagnosed this case as retroperitoneal hemorrhage due to aneurysm rupture, and we performed an angiogram and transcatheter arterial embolization to prevent aneurysm re-rupture. Based on a subsequent review of all the ndings for this patient, we retrospectively determined the cause of the ASPDA aneurysm to be SAM. Such case reports are rare, and further accumulation of similar cases is necessary in the near future to establish proper diagnostic criteria and appropriate treatment protocols.
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