Recto-sigmoid endoscopic ultrasonography(RS-EUS) has first been used in the staging of pelvic deep infil-trating endometriosis in the early 1990's. Since then, although publications have been sparse, RS-EUS is rou...Recto-sigmoid endoscopic ultrasonography(RS-EUS) has first been used in the staging of pelvic deep infil-trating endometriosis in the early 1990's. Since then, although publications have been sparse, RS-EUS is routinely used for this indication in few centers. In this paper, we focus on technical aspects and operating method of rectal and sigmoid endo-sonography, and describe the most characteristic echographic presen-tations of endometriosis of the lower digestive tract. Through a literature review, results obtained with dif-ferent types of endo-rectal probes, either flexible en-doscopic, or blind rigid, are presented and compared with those of other close imaging techniques: magnetic resonance imaging and the more recent trans-vaginal sonography. As well as these two latter techniques, RS-EUS appears as an interesting method in the staging of pelvic deep infiltrating endometriosis particularly to evaluate rectal and sigmoid infiltrations. However, more prospective studies are required, to correctly define respective indications for each exam, in the light of re-cent advancements in treating this frequent disease.展开更多
AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastri...AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.METHODS:Patients suffering from locally-advanced(T3-4 any N M0 or any T N1-3 M0)gastric carcinoma,staged with endoscopic ultrasound,bone scan,computed tomography,and laparoscopy,were assigned to receive four 21 d/cycles of TCF(docetaxel 75 mg/m 2 day 1,cisplatin 75 mg/m 2 day 1,and fluorouracil 300 mg/m 2 per day for days 1-14),either before(Arm A)or after(Arm B)gastrectomy.Operative morbidity,overall mortality,and severe adverse events were compared by intention-to-treat analysis.RESULTS:From November 1999 to November 2005,70 patients were treated.After preoperative TCF(Arm A),thirty-two(94%)resections were performed,85% of which were R0.Pathological response was complete in 4 patients(11.7%),and partial in 18(55%).No surgical mortality and 28.5%morbidity rate were observed,similar to those of immediate surgery arm(P= 0.86).Serious chemotherapy adverse events tended to be more frequent in arm B(23%vs 11%,P=0.07),with a single death per arm.CONCLUSION:Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.展开更多
Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging modalities.EUS can characterize lesions...Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging modalities.EUS can characterize lesions by providing information on echogenic origin,size,borders,homogeneity,and the presence of echogenic or anechoic foci.Linear echoendoscopes,and recently also electronic radial echoendoscopes,can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses,and thus permit the differentiation of vascular structures from cysts,as well as the assessment of the tumor blood supply.However,the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th layers.It is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using EUS.On the other hands,EUS guided fine needle aspiration(EUS-FNA) can provide samples for cytologic or histologic analysis.Hypoechoic lesions of the 3rd and the 4th EUS layers,more than in 1 cm diameter are recommended,and histologic confirmation using endoscopic submucosal resection or EUSFNA should be obtained when possible.Therefore,EUSFNA plays an important role in the clinical management of subepithelial tumors.Furthermore improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial展开更多
文摘Recto-sigmoid endoscopic ultrasonography(RS-EUS) has first been used in the staging of pelvic deep infil-trating endometriosis in the early 1990's. Since then, although publications have been sparse, RS-EUS is routinely used for this indication in few centers. In this paper, we focus on technical aspects and operating method of rectal and sigmoid endo-sonography, and describe the most characteristic echographic presen-tations of endometriosis of the lower digestive tract. Through a literature review, results obtained with dif-ferent types of endo-rectal probes, either flexible en-doscopic, or blind rigid, are presented and compared with those of other close imaging techniques: magnetic resonance imaging and the more recent trans-vaginal sonography. As well as these two latter techniques, RS-EUS appears as an interesting method in the staging of pelvic deep infiltrating endometriosis particularly to evaluate rectal and sigmoid infiltrations. However, more prospective studies are required, to correctly define respective indications for each exam, in the light of re-cent advancements in treating this frequent disease.
文摘AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.METHODS:Patients suffering from locally-advanced(T3-4 any N M0 or any T N1-3 M0)gastric carcinoma,staged with endoscopic ultrasound,bone scan,computed tomography,and laparoscopy,were assigned to receive four 21 d/cycles of TCF(docetaxel 75 mg/m 2 day 1,cisplatin 75 mg/m 2 day 1,and fluorouracil 300 mg/m 2 per day for days 1-14),either before(Arm A)or after(Arm B)gastrectomy.Operative morbidity,overall mortality,and severe adverse events were compared by intention-to-treat analysis.RESULTS:From November 1999 to November 2005,70 patients were treated.After preoperative TCF(Arm A),thirty-two(94%)resections were performed,85% of which were R0.Pathological response was complete in 4 patients(11.7%),and partial in 18(55%).No surgical mortality and 28.5%morbidity rate were observed,similar to those of immediate surgery arm(P= 0.86).Serious chemotherapy adverse events tended to be more frequent in arm B(23%vs 11%,P=0.07),with a single death per arm.CONCLUSION:Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.
基金Supported by The Japan Society for Promotion of Science,Research and Development Committee Program of The Japan Society of Ultrasonics in Medicine,Japan Research Foundation for Clinical Pharmacology,and Japanese Foundation for Research and Promotion of Endoscopy
文摘Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging modalities.EUS can characterize lesions by providing information on echogenic origin,size,borders,homogeneity,and the presence of echogenic or anechoic foci.Linear echoendoscopes,and recently also electronic radial echoendoscopes,can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses,and thus permit the differentiation of vascular structures from cysts,as well as the assessment of the tumor blood supply.However,the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th layers.It is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using EUS.On the other hands,EUS guided fine needle aspiration(EUS-FNA) can provide samples for cytologic or histologic analysis.Hypoechoic lesions of the 3rd and the 4th EUS layers,more than in 1 cm diameter are recommended,and histologic confirmation using endoscopic submucosal resection or EUSFNA should be obtained when possible.Therefore,EUSFNA plays an important role in the clinical management of subepithelial tumors.Furthermore improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial
