Colonoscopic Stigmata of 1 mm or Deeper Submucosal Invasion in Colorectal Cancer

Purpose  This study was designed to identify colonoscopic stigmata, indicating substantial invasion into the submucosa by T1 colorectal cancer with sessile morphology, including both flat and protruded types. Methods  A total of 111 Tis or T1 colorectal cancers were studied retrospectively. The lesions were divided into two groups: Group A (n = 83), Tis or T1 cancers with <1 mm submucosal invasion; and Group B (n = 28), T1 cancers with a ≥1 mm submucosal invasion. Printed photographs of the lesions were reviewed by five experienced colonoscopists who were blinded to histology. Deep depression, irregular surface, ulceration or erosion, fold convergence, and spontaneous bleeding were independently evaluated. Findings considered present by three or more reviewers were defined as positive. Kappa analysis was used to measure inter/intraobserver variability. Results  Positive rates of four findings but not fold convergence were significantly higher in Group B than in Group A. Irregular surface and spontaneous bleeding were significant independent predictors of ≥1 mm submucosal invasion, with diagnostic accuracies of 85.6 and 76.6 percent, respectively. Kappa analysis demonstrated fair-to-good inter/intraobserver agreement for spontaneous bleeding and fair-to-good intraobserver agreement for irregular surface. Conclusions  Irregular surface and spontaneous bleeding were colonoscopic stigmata, indicating ≥1 mm submucosal invasion in T1 colorectal cancer.     

Pillars in the colon

A case of Crohn's colitis with unusual endoscopic and morphologic appearances is reported. The colitis was asymptomatic and discovered incidentally. Histologic confirmation was obtained following segmental colectomy.     

Treatment of PPI-resistant gastro-oesophageal reflux: A systematic review

Background and study aims

Several studies have demonstrated the superiority of proton-pump inhibitors (PPIs) in resolving erosive gastro-oesophageal reflux disease (GORD). However, this first line of treatment can fail to control symptoms in around 30% of cases, especially in the presence of non-erosive GORD. In situations where the first line of treatment fails, there is a lack of concordance regarding the best strategy to apply. This study presents a systematic review of the trials which have tested second-line treatments after PPI failure.

胃间质瘤的内镜、病理和免疫组织化学特征

目的探讨胃间质瘤的内镜、病理和免疫组织化学特征。方法对外科手术切除的胃肿瘤标本用显微镜作初步观察，拟诊为间叶性肿瘤者再检查CD117、CD34、波形蛋白、结蛋白等抗原标记物。复习胃间质瘤患者术前临床资料，了解其内镜和临床特征。结果33例胃间叶肿瘤中，间质瘤28例。该28例中良性9例，交界性11例，恶性8例。胃镜下多呈黏膜下显著隆起性病变，10例表面存在深凹陷性溃疡。病灶位于胃底15例，胃体10例，胃窦3例。显微镜下细胞主要呈梭型和上皮细胞型，细胞排列呈栅栏状、旋涡状。免疫组织化学显示肿瘤组织中抗原表达阳性率为：CD117 100％(28／28)、CD117 100％(28／28)、波形蛋白100％(17／17)，而结蛋白无表达，S-100蛋白表达率仅为18．2％(4／22)。结论胃间质瘤是最常见的间叶性肿瘤，CD117、CD34可作为诊断胃间质细胞瘤的免疫标记物。     

腰椎椎间孔镜手术治疗伴神经根管狭窄的腰椎椎间盘突出症

目的退变性腰椎椎间盘突出、黄韧带肥厚、关节突关节增生内聚引起神经根管狭窄,利用椎间孔镜对神经根管进行减压。方法对20例退变性神经根管狭窄症患者行腰椎椎间孔镜下神经根管扩大成形术,记录术前术后腰腿痛疼痛视觉模拟量表(visual analogue scale,VAS)评分,采用Macnab标准评价疗效。结果 20例患者术前平均腰痛VAS评分为5分,术后即刻为1.5分,术后3个月为0.5分。术前平均腿痛VAS评分为7分,术后即刻为0.3分,术后3个月为0.1分。18例患者术后3个月的改良Macnab疗效评定为优,2例患者为良。结论对腰椎退变性神经根管狭窄症,椎间孔镜可对突出的腰椎椎间盘、关节突关节以及黄韧带进行减压,有效地扩大神经根管,可获得很好的疗效。     

经皮椎间孔镜治疗高龄腰椎椎间盘突出并神经根管狭窄的短期疗效

目的评价经皮椎间孔镜技术治疗高龄腰椎椎间盘突出并神经根管狭窄的临床效果。方法选择2012年11月~2013年6月本院收治的12例有典型根性症状及间歇性跛行的高龄患者,其中L4/L5间隙4例,L5/S1间隙3例,L3/L4/L5双间隙2例,L4/L5/S1双间隙3例,平均病程12.6个月。均采用经皮椎间孔镜技术治疗。结果 12例患者术后根性症状及间歇性跛行均明显缓解,直腿抬高试验阴性,采用疼痛视觉模拟量表(visual analogue scale,VAS)为患肢疼痛程度评分,术前为(8.1±1.3)分,术后3个月为(2.3±1.2)分,差异具有统计学意义(P0.05)。结论治疗有典型根性症状及间歇性跛行的腰椎椎间盘突出并根管狭窄的高龄患者,经皮椎间孔镜技术微创、安全、有效,合理选择手术适应证和成熟的椎间孔镜手术经验是手术成功的关键。